CurrentRegencePolicy 160

Femoroacetabular Impingement Surgery

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Coverage of open or arthroscopic femoroacetabular impingement surgery in skeletally mature patients when clinical, examination, imaging, and treatment-history criteria support medical necessity.

Policy Summary

PayerRegence

PolicyFemoroacetabular Impingement Surgery

Policy CodePolicy 160

Change TypeNo material change

Effective DateOctober 1, 2026

Last ReviewMay 1, 2026

Next Review DateNovember 1, 2026

Key ActionSubmit the history and physical, documented symptoms and conservative treatments, examination findings, and imaging supporting femoroacetabular impingement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Surgical approaches

A-EMedical necessity criteria

6Imaging examples

10/yearRecommended annual surgeon experience

2Codes not separately reportable

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CurrentRegencePolicy 160

Femoroacetabular Impingement Surgery

Customize your policy alerts

Sign up for regence Policy 160 alerts

Get alerted when Policy 160 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Coverage of open or arthroscopic femoroacetabular impingement surgery in skeletally mature patients when clinical, examination, imaging, and treatment-history criteria support medical necessity.

Policy Summary

PayerRegence

PolicyFemoroacetabular Impingement Surgery

Policy CodePolicy 160

Change TypeNo material change

Effective DateOctober 1, 2026

Last ReviewMay 1, 2026

Next Review DateNovember 1, 2026

Key ActionSubmit the history and physical, documented symptoms and conservative treatments, examination findings, and imaging supporting femoroacetabular impingement.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2Surgical approaches

A-EMedical necessity criteria

6Imaging examples

10/yearRecommended annual surgeon experience

2Codes not separately reportable

Medical Necessity and Coverage Criteria

Open or Arthroscopic FAI Surgery

Open or arthroscopic surgical treatment of femoroacetabular impingement (FAI) may be medically necessary in skeletally mature patients when all applicable policy criteria are met.

ALL criteria (A-E)

A. Moderate-to-severe hip pain that is worsened by flexion activities (e.g., squatting or prolonged sitting) and significantly limits activities.

Medical Necessity Considerations for Surgery

Medical necessity determinations should consider the clinical evidence supporting FAI pathology, the expected benefit of surgery, and the differing benefits and risks of open and arthroscopic approaches.

FAI morphology alone does not establish FAI pathology; not all patients with FAI morphology will have symptomatic disease.

FAI may be diagnosed through a combination of clinical evaluation, radiographs, and MR arthrography.

A positive impingement test, anterosuperior labral or acetabular damage identified on MR arthrography, and pistol-grip morphology on imaging together indicate a very high probability that the acetabular damage is caused by impingement of the femoral head-neck junction against the acetabular rim.

FAI can be verified intraoperatively.

Repair of the labrum alone may improve symptoms in the short term; debridement or osteoplasty of the bump or bone spur may reduce continued abrasion over the long term, although supporting studies are of low quality.

Treatment is most effective in younger patients without osteoarthritis or severe cartilage damage.

Patients who meet the policy criteria should make an informed choice between open and arthroscopic treatment because the approaches have differing benefits and risks.

In large case series, arthroscopic treatment in young to middle-age patients without osteoarthritis and with mild to moderate cartilage damage resulted in improvement in approximately 75% to 85% of patients.

Smaller case series found improvement in approximately 50% to 70% of young to middle-age patients undergoing open treatment with moderate to severe cartilage damage; non-union has been reported in 27% of patients following transection of the great trochanter with hip dislocation.

This policy addresses femoroacetabular impingement (FAI). It does not address acetabular dysplasia, which is considered part of developmental dysplasia of the hip (DDH), formerly described as congenital hip dislocation.

For skeletally mature patients, open or arthroscopic surgical treatment of FAI may be medically necessary when all policy criteria A-E are met.

Capsular plication, capsular repair, labral reconstruction, iliotibial band windowing, trochanteric bursectomy, abductor muscle repair, iliopsoas tenotomy, and similar incidental procedures performed during surgical treatment of FAI are considered components of and incidental to the FAI procedure.

Surgical treatment of FAI is considered not medically necessary when the policy criteria are not met because the procedure is not considered clinically effective or appropriate for those individuals.

Osteoplasty is unlikely to improve symptoms in patients with osteoarthritis classified as Tonnis grade II or III, a joint space of less than 2 mm, or severe cartilage damage classified as Outerbridge grade IV. These patients may require total hip arthroplasty for progressing pain within 5 years.

Coding and Clinical Thresholds

CPT CodesCPT

27299	Unlisted procedure, pelvis or hip joint.
29914	Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion).
29915	Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)
29916	Arthroscopy, hip, surgical; with labral repair.

HCPCS CodesHCPCS

29916

Arthroscopy, hip, surgical; with labral repair

Codes not separately reportable with CPT 29914-29916CPTNot Covered

29862	Not appropriate to report in addition to codes 29914-29916 because the reconstructive procedures described by codes 29914-29916 also involve the articular cartilage and/or labrum.
29863	Not appropriate to report in addition to codes 29914-29916 because the reconstructive procedures described by codes 29914-29916 also involve the articular cartilage and/or labrum.

Femoral head-neck offset alpha angle

ThresholdFemoral head-neck offset with an alpha angle greater than 50 degrees

DocumentationThe measurement may be documented on conventional x-rays, MRI, or MRI arthrogram

Associated morphologyMorphology indicative of cam-type or pincer-type femoroacetabular impingement

Joint space associated with increased THA risk

Joint-space thresholdLess than 2 mm

Associated riskPatients with joint space less than 2 mm were 39 times more likely to progress to total hip arthroplasty

Documentation and Submission Guidance

Documentation Required

Required Clinical Records

Submit the clinical records needed to determine whether policy criteria are met. Missing required information may affect the review and decision outcome.

History and physical.
Documented symptoms and conservative treatments attempted, specific to policy criterion 1.B.
Physical examination findings.
Related clinical records supporting the diagnosis and treatment request.

Documentation Required

Imaging Documentation

Submit imaging that documents morphology indicative of cam-type or pincer-type femoroacetabular impingement (FAI). Acceptable modalities include conventional x-rays, MRI, and MRI arthrogram.

Pistol-grip deformity.
Femoral head-neck offset with an alpha angle greater than 50 degrees.

Clinical Background

Femoroacetabular impingement (FAI) is localized compression of the hip caused by an anatomical mismatch between the femoral head and the acetabulum. In cam impingement, an asymmetric or nonspherical femoral head or neck contour contacts the acetabulum; in pincer impingement, acetabular overcoverage pinches the labrum. These morphologic abnormalities can damage the labrum and articular cartilage and contribute to hip pain, particularly with flexion activities such as squatting or prolonged sitting. Surgical treatment reshapes the abnormal femoral head and/or acetabulum to improve symptoms and potentially preserve the natural hip, using either an open or arthroscopic approach. Outcomes are most favorable in younger patients without osteoarthritis or severe cartilage damage.

Key Definitions

Femoroacetabular impingement (FAI)

DefinitionLocalized compression in the hip joint caused by an anatomical mismatch between the head of the femur and the acetabulum

Anatomic basisThe mismatch may result from a bony prominence at the head-neck junction or acetabular overcoverage

Potential effectImpingement may damage the acetabular rim, labrum, or articular cartilage

Cam impingement

DefinitionImpingement caused by an asymmetric or nonspherical contour of the femoral head or neck jamming against the acetabulum

Femoral morphologyA deformity at the head-neck junction may appear as a pistol-grip shape on radiographs

Policy Summary

PayerRegence

PolicyFemoroacetabular Impingement Surgery

Policy CodePolicy 160

Change TypeNo material change

Effective DateOctober 1, 2026

Last ReviewMay 1, 2026

Next Review DateNovember 1, 2026

Key ActionSubmit the history and physical, documented symptoms and conservative treatments, examination findings, and imaging supporting femoroacetabular impingement.

SourceLink

On This Page

Study outcomeIn one arthroscopic FAI treatment series, 10% of patients required total hip arthroplasty

Advanced joint-space narrowing

Advanced narrowingGreater than 50% joint-space narrowing

Joint-space thresholdLess than 2 mm joint space

Reported failure rate82% for hips with advanced preoperative joint-space narrowing

Risk factors for hip replacement

Joint-space risk factorJoint space of 2 mm or less

Preoperative MHHS risk factorPreoperative MHHS of less than 50

Associated outcomeBoth findings were identified as risk factors for hip replacement

Joint space

Joint-space thresholdLess than 2 mm

Expected outcomeThere is a high probability that symptoms will not improve following osteoplasty

Potential subsequent treatmentPatients may require total hip arthroplasty for progressing pain within 5 years

Osteoarthritis severity

Relevant thresholdTonnis grade II or III osteoarthritis

Expected outcomeThere is a high probability that symptoms will not improve following osteoplasty

More favorable severityTreatment is most effective in younger patients without osteoarthritis, classified as Tonnis grade 0 or I

Cartilage damage severity

Relevant thresholdOuterbridge grade IV cartilage damage

Expected outcomeThere is a high probability that symptoms will not improve following osteoplasty

Clinical implicationSevere cartilage damage is associated with limited improvement after osteoplasty

Acetabular retroversion, including overcoverage with crossover sign.

Coxa profunda or protrusion.

Damage of the acetabular rim.

Documentation Required

Clinical and Imaging Confirmation

Document FAI through a combination of clinical evaluation, radiographs, and MR arthrography. A positive impingement test, anterosuperior labral or acetabular damage on MR arthrography, and pistol-grip morphology on imaging provide a very high probability that the acetabular damage is caused by impingement; FAI can also be verified intraoperatively.

Clinical findings should be correlated with radiographic and MR arthrographic findings.
FAI morphology alone does not establish FAI pathology.

Documentation Required

Joint Degeneration and Cartilage Status

Document the degree of osteoarthritis, joint-space measurement, and cartilage status when evaluating FAI surgery. Treatment is most effective in younger patients without osteoarthritis (Tonnis grade 0 or I) or severe cartilage damage.

Include Tonnis grade when available.
Document whether the joint space is less than 2 mm.
Report cartilage damage, including Outerbridge grade when available.
Plain-film radiographs may identify osteoarthritis, but current imaging may not identify all articular damage.

Documentation Required

Pediatric Treatment Context

For pediatric patients with developmental hip disorders or slipped capital femoral epiphysis (SCFE), document the condition, treatment rationale, and applicable specialized-center involvement. Evidence is limited regarding outcomes and the appropriate selection, timing, and approach for pediatric FAI treatment.

The open dislocation procedure is technically demanding and carries a high risk of serious complications.
Subcapital correction osteotomy with surgical dislocation should be restricted to a few select specialized centers until long-term results and outcomes are available.
The surgical technique has a steep learning curve and should be learned at a specialized center.

Denial Risk

Incomplete Clinical Documentation

If the required clinical records, symptoms, conservative-treatment history, examination findings, or imaging are not submitted, the information available for review may be insufficient to determine whether policy criteria are met and may affect the review and decision outcome.

Submit all requested records with the authorization or medical-necessity review.

Denial Risk

Failure to Meet Policy Criteria

Surgical treatment of FAI is considered not medically necessary when the patient does not meet the policy criteria because the procedure is not considered clinically effective or appropriate for those individuals.

Ensure the submitted documentation establishes that all applicable policy criteria are satisfied.

Denial Risk

Advanced Osteoarthritis or Cartilage Damage

Osteoplasty is unlikely to improve symptoms in patients with advanced osteoarthritis or severe cartilage damage. These patients may require total hip arthroplasty (THA) for progressing pain within 5 years.

Tonnis grade II or III.
Joint space less than 2 mm.
Severe cartilage damage, including Outerbridge grade IV.

Denial Risk

Pediatric Open Dislocation Risk

For pediatric developmental hip disorders or SCFE, the balance of risks and benefits of treatment remains unclear. Open dislocation has a high risk of serious complications and has not been shown to be safe and effective outside a few highly specialized centers.

Consider the unclear risk-benefit profile, limited pediatric outcomes evidence, and unresolved questions regarding selection, timing, and surgical approach.
Restrict applicable open-dislocation treatment to select specialized centers with appropriate expertise.

Billing Rule

Do Not Separately Report Overlapping Arthroscopy Codes

Do not separately report CPT 29862 or CPT 29863 in addition to CPT 29914-29916. The reconstructive procedures described by CPT 29914-29916 also involve the articular cartilage and/or labrum.

Open FAI surgery: report CPT 27299, the unlisted procedure code for the pelvis or hip joint.
CPT 29914: hip arthroscopy with femoroplasty for treatment of a cam lesion.
CPT 29915: hip arthroscopy with acetabuloplasty for treatment of a pincer lesion.
CPT 29916: hip arthroscopy with labral repair.
CPT 29862 and CPT 29863 should not be separately reported with CPT 29914-29916.

Associated damageCam impingement may result in cartilage damage and delamination

Pincer impingement

DefinitionImpingement associated with overcoverage of the acetabulum and pinching of the labrum

Acetabular morphologyAcetabular overcoverage may produce pincer-type impingement

Potential damageIn isolated pincer impingement, damage may be limited to a narrow strip of acetabular cartilage

FAI syndrome

Diagnostic definitionA condition diagnosed using a combination of clinical signs and symptoms and characteristic imaging findings

Treatment optionsTreatment may include conservative care, rehabilitation, or surgery

Surgical contextSurgery may be open or arthroscopic and aims to improve hip morphology and repair damaged tissue

FAI morphology

DefinitionA radiographic or structural hip configuration, such as pistol-grip morphology

Clinical distinctionFAI morphology may be present without clinical FAI pathology

Pathologic contextMorphology may become pathologic with repetitive movement or increased force on the hip joint

Incidental FAI procedures

Capsular proceduresCapsular plication and capsular repair are considered components of and incidental to the FAI procedure

Labral and soft-tissue proceduresLabral reconstruction, iliotibial band windowing, trochanteric bursectomy, and abductor muscle repair are considered incidental to the FAI procedure

Tendon procedureIliopsoas tenotomy, and similar incidental procedures performed during FAI surgery, are considered components of and incidental to the FAI procedure