Total Joint Arthroplasty

Total knee and total hip arthroplasty are medically necessary for multiple specific indications including fractures, malignancy, avascular necrosis, failed prior procedures, and advanced joint disease with imaging evidence, attributable pain/functional disability, and unsuccessful conservative therapy (typically ≥3 months). Revision arthroplasty is covered for complications such as infection, component failure, instability, progressive bone loss, and symptomatic implant-related problems. Procedures are contraindicated for active joint or systemic infection, active skin infection at the surgical site, neuropathic arthritis, and rapidly progressing neurologic disease, and documentation (including imaging and the rationale for bypassing conservative care) and compliance with FDA device regulations are required for claims.

"Total knee arthroplasty (TKA) is medically necessary for failure of a previous osteotomy of the knee."