MedicaidCoverageHigh impact
Surgery of the Hip (for Pennsylvania Only)
UnitedHealthcare·PA · Orthopedics, General Surgery·Medical Policy
Effective date
Oct 1, 2026
We identified it
Sep 2, 2026
Summary
UnitedHealthcare Community Plan of Pennsylvania revised its hip surgery medical policy effective October 1, 2026. Key changes include: removal of CPT code 29860 from covered procedures, updated clinical coverage criteria referencing InterQual guidelines, and clarification that surgical treatment for Femoroacetabular Impingement Syndrome is NOT medically necessary when advanced osteoarthritis (Tönnis grade 2-3) or severe cartilage damage (Outerbridge Grade III-IV) is present. The policy also updated the HOOS definition and removed reference to certain diagnostic arthroscopy criteria.
Action Required
By September 30, 2026: Billing team must remove CPT code 29860 from the list of billable/covered procedures in the billing system for all UnitedHealthcare Community Plan of Pennsylvania (Medicaid) claims. Providers must document severity of osteoarthritis (Tönnis grade) and cartilage damage (Outerbridge grade) on all hip surgery prior authorization requests to establish medical necessity—claims for Femoroacetabular Impingement Syndrome procedures will be denied if advanced osteoarthritis or severe cartilage damage is present. Update prior authorization templates and denial response language to reference the revised InterQual criteria. Failure to comply will result in claim denials and potential contract compliance issues with UnitedHealthcare.