Medicare AdvantageCoverageHigh impact
Hip Arthroscopy - Medicare Advantage (Revised)
Humana·AL, GA, TN, NC, SC, VA, WV · Orthopedics, Sports Medicine·Medicare Advantage
Effective date
Jan 2, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicare Advantage has revised their hip arthroscopy coverage policy, establishing specific medical necessity criteria including required conservative treatment failure periods (3 months for general hip arthroscopy, 12 months for greater trochanteric pain syndrome) and specific clinical indications. The policy excludes coverage for advanced hip arthritis (Tonnis grade 3) and in-office needle arthroscopy procedures.
Action Required
Before January 2, 2026: Billing team must update prior authorization workflows for hip arthroscopy procedures to ensure documentation includes radiological reports, 3-month conservative treatment failure (or 12 months for greater trochanteric pain syndrome), and specific clinical criteria per the policy. Update encounter forms to remind providers to document required elements including impingement signs, pain patterns, and conservative treatment attempts. Flag CPT codes 27299, 29860-29863, 29914-29916, and 29999 in billing system for enhanced documentation review. Claims missing required documentation will be denied as medically unnecessary.