Surgery of the Hip – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare considers hip surgery, including arthroscopic treatment for femoroacetabular impingement (FAI), medically necessary only when the referenced InterQual® clinical criteria are met, and explicitly deems FAI surgery unproven and not medically necessary for patients with advanced osteoarthritis (Tönnis Grade 2–3) or severe cartilage damage (Outerbridge Grade III–IV). Coverage requires member-specific benefits and documentation meeting InterQual® criteria— including a complete diagnostic imaging interpretation, relevant clinical history, prior conservative treatments, and possible patient‑reported outcome measures—and documentation does not guarantee payment.

"Surgery of the hip and surgical treatment for Femoroacetabular Impingement (FAI) Syndrome is proven and medically necessary in certain circumstances."

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