Hip Resurfacing (HR)

This policy covers hip resurfacing (including total hip resurfacing) as an alternative to total hip arthroplasty for degenerative or inflammatory hip disease (e.g., osteoarthritis, rheumatoid arthritis, dysplasia, traumatic arthritis, avascular necrosis) in patients—particularly younger (<55) or highly active individuals—with radiographic involvement of the femoral head ≤50% who are candidates for hip replacement but unsuitable for traditional THA. Coverage is limited to procedures using FDA‑approved metal‑on‑metal devices performed by surgeons trained in the technique and only when all listed criteria are met (e.g., minimal acetabular cartilage change); exclusions include >50% femoral‑head involvement, active systemic infection, metal sensitivity, osteoporosis, significant renal insufficiency, women of childbearing potential, and other FDA‑listed contraindications or non‑FDA devices/indications.

"Degenerative joint disease (e."