CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Thermal Capsulorrhaphy Policy

Defines Blue Cross Blue Shield Rhode Island coverage position for thermal capsulorrhaphy (thermal/energy-induced capsular shrinkage) for treatment of joint instability in shoulder and other joints, and billing guidance for related codes.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyThermal Capsulorrhaphy Policy

Policy CodePolicy N/A

Change TypeInformational revision history

Effective DateFeb 3, 2015

Next Review DateN/A

Key ActionWhen there is no specific CPT code for thermal capsulorrhaphy in joints such as ankles, knees, wrist, hip, or elbow, report with CPT 29999 (unlisted arthroscopy procedure).

SourceLink

POLICY UPDATE CHANGES

Policy last updated 5/18/2022; policy states thermal capsulorrhaphy is not covered/not medically necessary.

Not coveredPrimary Coverage Position

2Code Guidance Items

5+Related References Cited

Coverage Summary

Thermal capsulorrhaphy is considered not covered / not medically necessary for treatment of joint instability, including but not limited to the shoulder, knee, and elbow. The procedure uses nonablative radiofrequency thermal energy to shrink collagen in joint capsules to tighten capsular laxity. Policy effective date: 02/03/2015; last reviewed/updated: 05/18/2022. Benefits and coverage may vary by contract; refer to the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for specific determinations.

Policy metadata

Policy titleThermal capsulorrhaphy

PayerBlue Cross Blue Shield - Rhode Island

Coverage stanceNot covered / Not medically necessary (not_covered_cosmetic)

Effective date02/03/2015

Last review05/18/2022

Policy statusCURRENT

Primary Coverage PositionThermal capsulorrhaphy is not covered as a treatment of joint instability; considered not medically necessary for Commercial Products.

Code Guidance ItemsHCPCS S2300 (arthroscopy, shoulder, with thermally-induced capsulorrhaphy) is not covered for Medicare Advantage and is not medically necessary for Commercial Products; use CPT 29999 (unlisted arthroscopy) when no specific CPT exists for other joints.

Related References CitedMultiple provider updates (2018–2022) and published clinical references reporting limited efficacy, complications, and chondrolysis concerns.

Medical Necessity / Coverage Determination

Policy Statement / Coverage Determination

Thermal capsulorrhaphy coverage determination:

Thermal capsulorrhaphy is not covered as a treatment of joint instability, including, but not limited to the shoulder; knee; and elbow, because the evidence is insufficient to determine that the technology results in an improvement in the net health outcome.

For Commercial Products: Thermal capsulorrhaphy is considered not medically necessary as a treatment of joint instability.

Benefits may vary between groups and contracts; refer to the applicable Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for specific coverage determinations.

Not Medically Necessary / Not Covered

Rationale: Available evidence is limited and does not demonstrate efficacy of thermal capsulorrhaphy for shoulder instability; few comparative studies do not support benefit and case series report high rates of unsatisfactory results and complications. Reported harms include complications such as glenohumeral chondrolysis. Because of insufficient evidence of net benefit and potential for net harm, the procedure is determined to be not covered/not medically necessary.

Coding Guidance

Not covered / Not medically necessary HCPCSHCPCSNot Covered

S2300

Arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy

Unlisted procedure code to be used when no specific CPT existsCPT

29999

Unlisted arthroscopy procedure (to be used for thermal capsulorrhaphy in ankles, knees, wrist, hip, or elbow when no specific CPT exists)

Provider Actions & Billing Impact

Denial Risk

Claims for S2300 and thermal capsulorrhaphy

HCPCS code S2300 (arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy) is not covered for Medicare Advantage plans and is considered not medically necessary for Commercial Products. Claims reported with S2300 are subject to denial.

S2300

Billing Rule

Use of Unlisted CPT for non-shoulder joints

When no specific CPT code exists for thermal capsulorrhaphy in non-shoulder joints, report the procedure using CPT 29999 (unlisted arthroscopy procedure). Examples of joints for which 29999 may be used include ankle, knee, wrist, hip, and elbow.

29999

Documentation Required

Refer to member-specific benefit documents

Benefits and coverage for thermal capsulorrhaphy vary by contract. Providers must check the member's Benefit Booklet, Evidence of Coverage, or Subscriber Agreement for the applicable coverage determination before billing.

Background, Evidence & Definitions

Thermal capsulorrhaphy is an arthroscopic technique using thermal (laser or radiofrequency) energy applied to capsular tissue to induce collagen shrinkage and reduce capsular volume/tension, proposed to treat capsular laxity and shoulder instability. It was investigated as a simpler arthroscopic method to restore capsular tension and has been used alone or with other arthroscopic repairs. The literature does not support its use: comparative studies do not show efficacy for shoulder instability, and case series report a high rate of unsatisfactory results and complications (including reports of shoulder chondrolysis). This insufficient evidence of benefit and concern for potential harm underlie the noncoverage determination.

Evidence Type	Summary
Comparative studies
Few available comparative studies do not support efficacy for shoulder instability
Case series
Case series report a high rate of unsatisfactory results and complications, with potential for net harm (including concerns such as chondrolysis)

Thermal capsulorrhaphy: Arthroscopic application of thermal (laser or radiofrequency) energy to capsular tissue to induce shrinkage and reduce capsular volume/tension.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyThermal Capsulorrhaphy Policy

Policy CodePolicy N/A

Change TypeInformational revision history

Effective DateFeb 3, 2015

Next Review DateN/A

Key ActionWhen there is no specific CPT code for thermal capsulorrhaphy in joints such as ankles, knees, wrist, hip, or elbow, report with CPT 29999 (unlisted arthroscopy procedure).

SourceLink

On This Page

OpenPayer

Thermal Capsulorrhaphy Policy

Coverage Summary

Medical Necessity / Coverage Determination

Not Medically Necessary / Not Covered

Coding Guidance

Provider Actions & Billing Impact

Background, Evidence & Definitions

Revision History