CurrentUnitedHealthcarePolicy CS343KS.02

Surgery of the Hand or Wrist (Kansas)

Defines UnitedHealthcare's medical policy for surgical procedures of the hand or wrist and the use of InterQual clinical criteria to determine medical necessity for members in Kansas.

Policy Summary

PayerUnitedHealthcare

PolicySurgery of the Hand or Wrist (Kansas)

Policy CodePolicy CS343KS.02

Change TypeRoutine reviewclarified — no material change

Effective DateJul 1, 2025

Next Review Date

Key ActionUse the InterQual CP: Procedures criteria and follow applicable plan prior authorization processes when requesting coverage for hand or wrist surgery.

SourceLink

POLICY UPDATE CHANGES

Routine review; no change to coverage guidelines

2025-07-01effective date of current version

1state this policy applies to

7+InterQual CP procedures referenced

multipleCPT codes listed for reference

Coverage and Medical Necessity Criteria

InterQual-based medical necessity

Policy Summary

PayerUnitedHealthcare

PolicySurgery of the Hand or Wrist (Kansas)

Policy CodePolicy CS343KS.02

Change TypeRoutine reviewclarified — no material change

Effective DateJul 1, 2025

Next Review Date

Key ActionUse the InterQual CP: Procedures criteria and follow applicable plan prior authorization processes when requesting coverage for hand or wrist surgery.

SourceLink

On This Page

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.

InterQual-based coverage: Medical necessity for the following hand and wrist surgeries is determined by meeting the specific InterQual CP: Procedures criteria referenced in this policy (e.g., arthroplasty CMC/MCP/PIP, diagnostic and therapeutic wrist arthroscopy, wrist joint replacement, and removal or revision of wrist arthroplasty).

Providers and reviewers must consult the InterQual criteria linked in the policy for the detailed inclusion/exclusion and decision logic.

Applicable Codes and Coding Notes

Applicable CPT Codes (part 1)CPT

25441	Arthroplasty with prosthetic replacement; distal radius.
25442	Arthroplasty with prosthetic replacement; distal ulna.
25443	Arthroplasty with prosthetic replacement; scaphoid carpal (navicular).
25444	Arthroplasty with prosthetic replacement; lunate.
25445	Arthroplasty with prosthetic replacement; trapezium.
25446	Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (total wrist).
25449	Revision of arthroplasty, including removal of implant, wrist joint.
26530	Arthroplasty, metacarpophalangeal joint; each joint

Applicable CPT Codes (part 2)CPT

26531	Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each joint.
26535	Arthroplasty, interphalangeal joint; each joint.
26536	Arthroplasty, interphalangeal joint; with prosthetic implant, each joint.
29840	Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure).
29843	Arthroscopy, wrist, surgical; for infection, lavage and drainage.
29844	Arthroscopy, wrist, surgical; synovectomy, partial.
29845	Arthroscopy, wrist, surgical; synovectomy, complete.
29846	Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridement.
29847	Arthroscopy, wrist, surgical; internal fixation for fracture or instability

Provider Requirements, Prior Authorization, and Billing Guidance

Prior Authorization

Provider Requirements and Prior Authorization Expectations

Medical necessity for the procedures described in this policy is determined using InterQual® clinical criteria. Providers should reference and follow the applicable InterQual CP criteria when requesting services and preparing documentation for review.

Prior authorization is expected where plan rules require it; follow payer-specific prior authorization submission processes and include InterQual-supported documentation to demonstrate medical necessity.
Inclusion of a code in this policy is for reference only and does not guarantee coverage, payment, or reimbursement; benefit plan terms, federal/state law, and contract language govern coverage decisions.
When determining coverage and submitting claims, providers must reference the member's governing benefit documents (federal, state, and contractual requirements) as those terms override standard policy language in case of conflict.

Clinical Background

Surgical procedures of the hand and wrist address a range of clinical problems including joint pathology, fracture or instability, infection, synovial disease, and degenerative conditions. Typical operative interventions referenced in this policy include arthroplasty of small joints (e.g., carpometacarpal, metacarpophalangeal, proximal interphalangeal), diagnostic and therapeutic wrist arthroscopy (for synovectomy, debridement, lavage/drainage, repair or internal fixation), wrist joint replacement, and revision or removal of wrist arthroplasty. Medical necessity for these procedures is determined using the InterQual CP: Procedures criteria cited in the policy.

Definitions and Terminology

InterQual CP: Procedures — referenced procedures

InterQual CP procedures referencedArthroplasty: CMC (thumb), MCP (digits), PIP (fingers)

Wrist arthroscopyArthroscopy or arthroscopically assisted surgery of the wrist; diagnostic arthroscopy with or without synovial biopsy

Wrist joint replacementJoint replacement, wrist (wrist arthroplasty)

Revision/removalRemoval or revision of wrist arthroplasty (revision of arthroplasty, including removal of implant)

How to applyMedical necessity is determined by meeting the specific InterQual CP: Procedures criteria listed in this policy; consult the linked InterQual criteria for detailed decision logic