CurrentCareFirstPolicy 7.01.029

THERMAL SHRINKAGE FOR JOINT INSTABILITY

Defines CareFirst's coverage position on arthroscopic thermocapsular shrinkage (thermal capsulorrhaphy) for treatment of joint instability or laxity across joints (shoulder and others). Applies as a medical policy reference and notes contract-specific benefit precedent.

Policy Summary

PayerCareFirst

PolicyTHERMAL SHRINKAGE FOR JOINT INSTABILITY

Policy CodePolicy 7.01.029

Change TypeClarified / literature update

Effective Date

Next Review Date

Key ActionVerify member's contract for benefits and any local, state, or federal coverage requirements because contract provisions supersede this clinical policy.

POLICY UPDATE CHANGES

Policy labeled ARCHIVED and last reviewed/ revised on 03/01/2024; policy statement remains that thermal shrinkage is experimental/investigational for all indications.

All indicationsCoverage status

Policy archivedPolicy state

Coverage Summary & Determination

Coverage Determination: Thermal shrinkage is considered experimental/investigational as a treatment for all indications as it does not meet TEC criteria #2 - 5. Policy state: ARCHIVED (last reviewed/revised 03/01/2024). Multiple literature updates through 2023 did not change the policy determination.

policy_number7.01.029

statusARCHIVED

last_review2024-03-01

scope_summaryDefines CareFirst's coverage position on arthroscopic thermocapsular shrinkage (thermal capsulorrhaphy) for treatment of joint instability or laxity across joints (shoulder and others). Applies as a medical policy reference and notes contract-specific benefit precedent.

What Providers Need to Do

Documentation Required

Benefit verification required

Verify member's contract for benefits and any local, state, or federal coverage requirements because contract provisions supersede this clinical policy.

Denial Risk

Services considered experimental/investigational

Claims for thermal capsulorrhaphy for any joint may be denied as experimental/investigational per this policy statement.

Claims may be denied for thermal capsulorrhaphy for any joint per this policy statement.

Background & Evidence Summary

Thermal capsulorrhaphy (arthroscopic thermocapsular shrinkage) uses radiofrequency/electrothermal probes to heat collagen in the joint capsule, causing the tissue to shrink and tighten to reduce laxity. It has been proposed as both a stand-alone treatment and as an adjunct to labral or ligament repairs. The technique has been proposed primarily for the shoulder (to address chronic or recurrent instability, subluxation, and pain) and has also been proposed for other joints including the knee, wrist, elbow, and ankle.

Evidence summary

Evidence qualityWeak; lack of RCTs, small sample sizes, inconsistent protocols, and limited long-term follow-up

Regulatory statusSeveral radiofrequency probe devices cleared via 510(k)

Experimental/Investigational definition: Services or supplies in the developmental stage undergoing testing and not meeting BCBSA/MPS Assessment Criteria (five criteria) for coverage. The term describes services or supplies that are in the developmental stage and are in the process of human or animal testing; services that do not meet all five specified criteria (final regulatory approval, sufficient scientific evidence on health outcomes, improvement in net health outcome, equivalence to established alternatives, and attainability of improvement outside investigational settings) are deemed experimental/investigational.

Policy Updates

2024-03-01policy_reviewLatest

Policy labeled ARCHIVED and last reviewed/revised on 03/01/2024; multiple literature updates reviewed through 2023 did not change the policy determination and the policy statement remains that thermal shrinkage is experimental/investigational for all indications.