CurrentBlue Cross Blue Shield - Rhode IslandPolicy N/A

Medical Coverage Policy | as a Treatment of Joint Instability sad

Defines coverage position for thermal capsulorrhaphy as a treatment for joint instability (shoulder, knee, elbow, and other joints) for BlueCHiP for Medicare and Commercial products, including coding guidance for unlisted arthroscopy and HCPCS S2300.

Policy Summary

PayerBlue Cross Blue Shield - Rhode Island

PolicyMedical Coverage Policy | as a Treatment of Joint Instability sad

Policy CodePolicy N/A

Change TypeNo material change

Effective DateFeb 3, 2015

Next Review Date

Key ActionWhen no specific CPT code exists for thermal capsulorrhaphy in the ankles, knees, hip, wrist, or elbow, report CPT 29999 (Unlisted arthroscopy procedure).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes.

1Not covered / not medically necessary

2Products referenced

Coverage Summary

Thermal capsulorrhaphy for treatment of joint instability (including the shoulder, knee, elbow, and other joints) is considered not covered / not medically necessary (coverage stance: not_covered_cosmetic). Effective date: 2015-02-03; Last review: 2018-07-03.

Coverage Determination

Thermal capsulorrhaphy is considered not covered / not medically necessary for treatment of joint instability including but not limited to the shoulder, knee, and elbow:

ALL of the following

BlueCHiP for Medicare: Thermal capsulorrhaphy is considered not covered as a treatment of joint instability, including, but not limited to the shoulder, knee, and elbow, as the evidence is insufficient to determine the effects of the technology on health outcomes.
Commercial Products: Thermal capsulorrhaphy is considered not medically necessary as a treatment of joint instability, including, but not limited to the shoulder, knee, and elbow, as the evidence is insufficient to determine the effects of the technology on health outcomes.

Medical-Necessity / Not Medically Necessary

Thermal capsulorrhaphy not covered / not medically necessary for joint instability

Thermal capsulorrhaphy is considered not covered / not medically necessary for treatment of joint instability including but not limited to the shoulder, knee, and elbow:

ALL of the following

BlueCHiP for Medicare: Thermal capsulorrhaphy is considered not covered as a treatment of joint instability, including, but not limited to the shoulder, knee, and elbow, as the evidence is insufficient to determine the effects of the technology on health outcomes.
Commercial Products: Thermal capsulorrhaphy is considered not medically necessary as a treatment of joint instability, including, but not limited to the shoulder, knee, and elbow, as the evidence is insufficient to determine the effects of the technology on health outcomes.

ref

Evidence summaries report that the few available comparative studies do not support efficacy of thermal capsulorrhaphy, and case series show high rates of unsatisfactory results and complications. Given the lack of demonstrated benefit and potential for harm, thermal capsulorrhaphy is considered not medically necessary.

Coding

HCPCS code specifically for thermally-induced capsulorrhaphy (not covered / not medically necessary)HCPCSNot Covered

S2300

Arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy

Billing Rule

Use of unlisted arthroscopy code when no specific CPT exists

When no specific CPT code exists for thermal capsulorrhaphy in the ankles, knees, hip, wrist, or elbow, report CPT 29999 (Unlisted arthroscopy procedure).

29999

Denial Risk

Claims for thermal capsulorrhaphy will be denied/not covered

Claims billed with HCPCS S2300 will be considered not covered for BlueCHiP for Medicare and not medically necessary for Commercial Products; thermal capsulorrhaphy is considered not covered/not medically necessary for joint instability.

S2300
29999
BlueCHiP for Medicare
Commercial Products

Provider Actions & Billing Impact

Billing Rule

Use of unlisted arthroscopy code when no specific CPT exists

As there is no specific CPT code available for the use of thermal capsulorrhaphy in the ankles, knees, hip, wrist, or elbow, report the unlisted arthroscopy code 29999 (Unlisted arthroscopy procedure).

29999

Denial Risk

Claims for thermal capsulorrhaphy will be denied/not covered

The HCPCS code S2300 (arthroscopy, shoulder, surgical; with thermally-induced capsulorrhaphy) is not covered for BlueCHiP for Medicare and is considered not medically necessary for Commercial Products; claims for thermally-induced capsulorrhaphy coded with S2300 or unlisted arthroscopy coding may be denied or deemed not medically necessary for these products.

S2300
29999
BlueCHiP for Medicare
Commercial Products

Operational note: Claims for thermally-induced capsulorrhaphy (HCPCS S2300) and related procedures will be denied/not covered; when no specific CPT exists for a joint, report 29999. Expect denial for thermal capsulorrhaphy claims and consult this policy for alternative procedure coding guidance.

Background and Evidence Summary

Thermal capsulorrhaphy uses thermal energy (laser or radiofrequency) to alter collagen in the capsule or ligaments to reduce capsular volume and increase tension. It was primarily evaluated for shoulder instability but has been proposed for capsular laxity in other joints. Devices historically used include laser and radiofrequency systems such as the Oratec ORA-50 and ArthroCare probes. Although proposed as a simpler arthroscopic tightening technique (sometimes used with repair of labral or ligament tears or as a sole treatment), concerns exist about safety and effectiveness.

Supporting evidence: The literature contains few comparative studies and multiple case series. Comparative studies do not demonstrate efficacy for shoulder instability, and case series report a high rate of unsatisfactory outcomes and complications, supporting the determination of not medically necessary.

Term	Definition
Thermal capsulorrhaphy	Procedure using thermal energy (laser or radiofrequency) to alter collagen in the capsule/ligaments to reduce capsular volume and increase tension.

Definitions

Definitions and key points

Thermal capsulorrhaphyProcedure using thermal energy (laser or radiofrequency) to alter collagen in the capsule/ligaments to reduce capsular volume and increase tension.

Primary indicationEvaluated primarily for shoulder joint instability; may be proposed for capsular laxity in other joints (knee, elbow, etc.).

Devices/energyHistorically used laser and radiofrequency probes (e.g., Oratec ORA-50, ArthroCare).

Evidence summaryFew comparative studies do not support efficacy; case series report high rates of unsatisfactory results and complications, raising potential for net harm.

Coding guidanceWhen no specific CPT exists for other joints use 29999 (Unlisted arthroscopy); HCPCS S2300 describes arthroscopy with thermally-induced capsulorrhaphy and is not covered/not medically necessary.