Thermal Capsulorrhaphy as a Treatment of Joint Instability

This policy covers thermal capsulorrhaphy — arthroscopic application of radiofrequency thermal energy to tighten the joint capsule — primarily for glenohumeral (shoulder) instability (traumatic, microtrauma, multidirectional, overhead athletes, congenital hyperlaxity) and other joint instability such as chronic ankle instability with isolated ATFL lesions. Major limitations/requirements: the procedure is considered experimental/investigational and the policy is inactive for claims adjudication, is reserved for patients who fail conservative management, and is discouraged by evidence showing no clear benefit over suture repair, higher recurrent instability rates, and serious complications (including reported glenohumeral chondrolysis).

"Shoulder instability resulting from a single traumatic event (subluxation or dislocation)."

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