Knee arthroscopy billing and reimbursement
Defines coding, billing, documentation, modifier and reimbursement guidance for knee arthroscopy procedures for Priority Health providers; applies to claims submission, authorization, and payment evaluation.
No material clinical or coverage changes in this revision.
Coverage and Billing Rules
Coverage and billing rules — knee arthroscopy
Billing and coding rules and restrictions that determine reimbursable submissions for knee arthroscopy procedures.
Governance, documentation, and coding requirements
Billing and coverage are governed by federal/state guidance and Priority Health billing policies; failures in documentation or coding may lead to denial or recoupment.
Procedure Codes, Modifiers, and Coding Rules
| 29850 | Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy) |
| 29851 | Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; with internal or external fixation (includes arthroscopy) |
| 29866 | Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s]) |
| 29867 | Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty) |
| 29868 | Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral |
| 29870 | Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure) |
| 29871 | Arthroscopy, knee, surgical; for infection, lavage and drainage |
| 29873 | Arthroscopy, knee, surgical; with lateral release |
| 29874 | Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation) |
| 29875 | Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure) |
| Modifiers 59, XE, XS, XP, XU | Guidance on use of separate or distinct service modifiers |
Authorization, Documentation, and Provider Responsibilities
Prior Authorization / Pre-Service Organization Determination (PSOD)
For Medicare indications that do not meet the criteria of an NCD, local LCD, or a specific Priority Health medical policy, a Pre-Service Organization Determination (PSOD) must be completed prior to performing the service. Providers should follow the PSOD process and timelines; click here for additional details on PSOD. Authorization may also be required for services based on place of service, benefit plan, or procedure-specific rules. Check the applicable authorization system (e.g., TurningPoint/prism) and the member's benefit plan to determine pre-service requirements.
- PSOD required when indication does not meet NCD/LCD or specific policy
- Verify and obtain prior authorization when indicated via TurningPoint/prism or other Priority Health authorization tools
- Medicare-specific PSOD process must be followed
Documentation Requirements
Complete and thorough medical record documentation that substantiates the service performed is the responsibility of the Provider. Documentation must support the medical necessity, the service performed, and any billing/coding submitted. Providers should consult applicable clinical guidelines and any policy-specific documentation checklists.
- Document laterality: specify affected side — right, left, or bilateral
- Site and location: specify exact anatomic site (e.g., medial compartment of the right knee)
- Severity and status: describe severity of condition(s), current status, and response to prior treatments
- Procedure details: describe what was performed, supplies/DME used, and operative or procedure notes as applicable
Authorization is Not a Guarantee of Payment
An authorization or PSOD determination does not guarantee payment. Authorization confirms that pre-service administrative review occurred but payment remains subject to adherence to coding, billing, documentation, and medical necessity requirements. Priority Health may perform pre- or post-claim reviews and may deny, recoup, or reject claims if documentation or coding requirements are not met.
- Authorization is not a payment guarantee — services must be performed and fully documented to the highest level of specificity to support billed CPT/HCPCS/revenue codes
- Priority Health may recover payment or deny claims if government program regulations, policy rules, or contractual requirements are not followed
- Payment integrity reviews (pre- or post-claim) may be performed to validate billing and coding accuracy
Authorization and Medical Necessity
Authorization requirements and medical necessity criteria appropriate to the procedure, diagnosis, and frequency remain applicable. Providers must meet these criteria and maintain supporting documentation; failure to do so may affect payment and could result in claim denial or recoupment.
- Obtain required authorizations and ensure services meet medical necessity criteria
- Maintain documentation that substantiates the necessity, frequency, and scope of services
- Follow CPT, HCPCS, revenue code, CMS and MDHHS coding guidance when reporting services
Definitions and Policy Notes
Change and Review History
Date of origin recorded for the policy document.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.