Knee Arthroplasty - Medicare Advantage

Covers knee arthroplasty procedures—including total knee arthroplasty (TKA), unicompartmental/partial (UKA), bicompartmental and bi‑unicompartmental replacements—consisting of resection and prosthetic resurfacing of diseased knee compartments. Indications are for severe symptomatic joint disease (eg, osteoarthritis, rheumatoid/inflammatory arthritis, posttraumatic degenerative disease, osteonecrosis) and revision/replacement scenarios, but coverage is limited to severe symptomatic cases, is governed by applicable CMS LCDs/NCDs and MAC jurisdictional rules, and may be subject to additional medical‑necessity, prior‑authorization or selection criteria in the full LCD/LCA given limited quality of evidence.

"No specific documentation requirements are provided in this document chunk; follow documentation requirements specified in the applicable MAC LCDs/LRAs and CMS guidance."