Medicare AdvantageCoverageHigh impact
Knee Arthroscopy - Medicare Advantage (Revised)
Humana·Orthopedics, Sports Medicine·Medicare Advantage
Effective date
May 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has updated their knee arthroscopy policy, establishing new medical necessity criteria requiring documentation of radiological findings and failure of conservative treatment (physical therapy plus steroids, NSAIDs, or orthotics) before approval. The policy also excludes coverage for needle arthroscopy and extraarticular knee injuries.
Action Required
Before May 1, 2026: Billing team must update prior authorization requests for Humana Medicare Advantage knee arthroscopy claims to include radiological interpretation reports and documentation of failed conservative treatment (physical therapy plus one of: intra-articular steroids, NSAIDs, or orthotics). Providers must document specific indications from the approved list. Stop billing CPT 29999 for needle arthroscopy as it will be denied. Update encounter forms to remind providers of documentation requirements. Claims without proper documentation will be denied.