Surgical Treatment of Femoroacetabular Impingement

Covers surgical treatment (open or arthroscopic) of femoroacetabular impingement (FAI) — including arthroscopic procedures (CPT 29914–29916; 29862, 29863) — for skeletally mature patients with symptomatic cam or pincer morphology causing labral and/or anterosuperior cartilage damage. Coverage requires failed conservative therapy ≥3 months, a positive impingement exam and imaging clearly linking FAI to joint damage, absence of advanced osteoarthritis (no Tönnis grade 2–3; joint space ≥2 mm) or Outerbridge grade IV chondral lesions, and must be performed at centers and by surgeons experienced in FAI; procedures not meeting all criteria (or in skeletally immature/asymptomatic patients) are not covered.

"Surgical treatment for femoroacetabular impingement (FAI) when FAI is present."

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