Hip, Knee and Shoulder Arthroscopic Surgeries - Medicare Advantage

This policy governs coverage of hip, knee and shoulder arthroscopic surgeries (e.g., hip arthroscopy for femoroacetabular impingement, labral repair/reconstruction, loose‑body removal, lavage for infection, and select shoulder arthroscopic procedures) for Humana Medicare Advantage members, with coverage determined only as specifically allowed by applicable Medicare NCDs and LCDs. Coverage generally requires imaging documentation (X‑ray/CT/MRI), failure of at least three months of conservative therapy (including intra‑articular steroid when appropriate and NSAIDs/non‑opioid analgesics), absence of advanced osteoarthritis for hip arthroscopy (no Tonnis grade 2–3), and is subject to NCD 150.9, MAC/LCD jurisdictional rules, and member‑specific coverage documents.

"None specified in this document chunk. (The chunk contains general policy statement only; no explicit documentation requirements provided."