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Knee Arthroscopy - Medicare Advantage (Revised)
Effective date
Nov 2, 2026
Identified
Nov 3, 2026
Previous versions
- Knee Arthroscopy - Medicare Advantage (Revised) · effective May 1, 2026
Summary
Humana revised its Medicare Advantage knee arthroscopy coverage policy (HUM-1286-002), with the source stating an effective date of 11/02/2026 and a review date of 10/13/2026. The policy sets criteria for when arthroscopic knee procedures are medically reasonable and necessary, including documented imaging, failed provider-directed conservative management, and specific indications for articular cartilage lesions, diagnostic arthroscopy, meniscal tears, ligament injuries, synovial disease, and others, and it excludes arthroscopy for severe osteoarthritis (Outerbridge Grade III or IV) and needle arthroscopy (29999).
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What to do
Action · 4 steps
01Already effective 11/02/2026: Billing team should confirm that charge entry and claim edits for Humana Medicare Advantage members reflect the revised criteria for knee arthroscopy codes listed in the policy, and that claims include supporting documentation such as imaging reports, records of failed conservative management including physical therapy, and objective findings for the specific indication.
02Providers and front desk staff should be told before scheduling these procedures for Humana Medicare Advantage members that prior authorization and documentation of the listed criteria are needed, since claims without that documentation are likely to be denied.
03Needle arthroscopy (29999) and procedures primarily treating severe knee osteoarthritis should be flagged as not covered under this policy.
04Watch for the payer's next notice, as the policy lists a review date of 10/13/2026.
Codes mentioned
27599298502985129870298712987329874298752987629877298792988029881298822988329884298852988629887298882988929999S2112
Original notice
Knee Arthroscopy - Medicare Advantage (Revised)
mcp.humana.com · Always check the source before changing claims.
Related changes
See all Humana changes →Knee Arthroscopy - Medicare Advantage (Revised)HighEffective May 1, 2026 · Medicare AdvantageKnee Arthroplasty - Medicare Advantage (Revised)HighEffective Nov 2, 2026 · Medicare AdvantageHip Arthroscopy - Medicare Advantage (Revised)HighEffective Jan 2, 2026 · Medicare AdvantageKnee Arthroplasty - Medicare Advantage (Revised)HighEffective Mar 16, 2026 · Medicare AdvantageBrowse every Humana change in the policy list
Related policy hubs
Humana policiesOrthopedicsSports MedicinePM&R (Physical Medicine & Rehab)Code 27599Code 29850Code 29851Code 29870Code 29871Code 29873Code 29874Code 29875Code 29876Code 29877Code 29879Code 29880Code 29881Code 29882Code 29883Code 29884Code 29885Code 29886Code 29887Code 29888Code 29889Code 29999Code S2112