Surgery of the Hip (including Femoroacetabular Impingement treatment)
UnitedHealthcare medical policy applicable to Idaho (including Idaho Medicaid Plus) addressing coverage rationale for hip surgery and surgical treatment for Femoroacetabular Impingement (FAI) Syndrome, referenced to InterQual procedures and listing applicable CPT/HCPCS codes and clinical definitions/evidence. It documents when surgical treatment is considered proven/medically necessary and when it is unproven/not medically necessary.
New Medical Policy created effective 06/01/2025.
Coverage Summary
UnitedHealthcare medical policy for Surgery of the Hip (Idaho only) addressing surgical treatment for Femoroacetabular Impingement (FAI) Syndrome and related hip procedures. Scope: applicable to Idaho, including Idaho Medicaid Plus, and references InterQual clinical preference (CP) criteria for hip procedures (arthroscopy — diagnostic and surgical, arthrotomy, hemiarthroplasty, and total joint replacement). Coverage stance (high-level): mixed — procedures are proven and medically necessary when InterQual CP criteria are met, but surgical treatment for FAI is unproven and not medically necessary when Tonnis Grade 2 or 3 (advanced osteoarthritis) or Outerbridge Grade III or IV (severe cartilage damage) are present. Effective date: 2025-06-01. Status: CURRENT.
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