MedicaidCoverageHigh impact
Surgery of the Hip (for Nebraska Only)
UnitedHealthcare·NE · Orthopedics, General Surgery·Medical Policy
Effective date
Dec 1, 2026
We identified it
Oct 3, 2026
Summary
UnitedHealthcare Community Plan of Nebraska revised its hip surgery medical policy effective December 1, 2026. The policy removed the diagnostic arthroscopy InterQual criterion, deleted CPT code 29860, and added explicit exclusion criteria: 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. Billing teams must immediately identify claims for CPT 29860 and update authorization protocols for hip procedures.
Action Required
By November 30, 2026: (1) Billing team must remove CPT code 29860 from all active billing templates and EMR encounter forms for Nebraska Medicaid patients. (2) Update billing system to flag any pending or future claims with CPT 29860 for manual review and denial preparation. (3) Providers must document Tönnis grade and Outerbridge grade in operative notes for all hip arthroscopy and FAI procedures to support medical necessity determination. (4) Prior authorization staff must update approval protocols to require preoperative imaging documentation showing Tönnis grade 0-1 and Outerbridge Grade 0-II for Femoroacetabular Impingement Syndrome surgical approvals. Failure to comply will result in claim denials and potential member balance issues for Nebraska Medicaid patients.