Total Joint Arthroplasty

Total knee and hip arthroplasty are medically necessary for advanced joint disease or trauma causing pain and ADL-limiting functional disability when supported by radiographic/MRI evidence and, when appropriate, documented failure of conservative therapy. Revision arthroplasty is covered for component loosening, mechanical failure, infection, periprosthetic fracture, significant bone loss, implant wear, instability, or other specified complications; active joint or systemic infection and certain other contraindications preclude coverage unless a clear rationale is documented.

"Total knee arthroplasty (TKA) is medically necessary when advanced joint disease is demonstrated by radiographic evidence or, if radiography is inadequate, MRI evidence (eg, subchondral cysts, subc..."

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