AIM (out-of-state / Federal BCBS) Knee Arthroscopy prior authorization requirements (2026)
What AIM (out-of-state / Federal BCBS) generally requires to approve Knee Arthroscopy (CPT 29875, 29876, 29877, 29879), for commercial plans. Yes. AIM (out-of-state / Federal BCBS) generally requires prior authorization for Knee Arthroscopy (CPT 29875, 29876, 29877, 29879).
Medical-necessity criteria AIM (out-of-state / Federal BCBS) generally applies
Prior authorization via Carelon (for participating Anthem/BCBS/FEP plans). Acute traumatic meniscal tear (repair or meniscectomy): injury within 3 months, mechanical symptoms (catching/locking/instability), at least two positive exam findings, and imaging confirming acute tear. Chronic degenerative tear: at least two exam findings, persistent mechanical symptoms OR failure of conservative management for at least 3 months, confirmatory imaging, and no more than moderate OA (joint-space at least 50% preserved / KL grade 2 or less). Meniscectomy is excluded when associated with KL grade 3 or worse (exception possible under age 40). Carelon Joint Surgery MSK02-1125.1.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Knee Arthroscopy. Confirm the covered diagnosis list against the current AIM (out-of-state / Federal BCBS) policy.
How to submit
- Method: Carelon ProviderPortal
- Portal: Carelon Medical Benefits Management
Sources & verification
- BindingSource — Carelon Clinical Appropriateness Guidelines — Joint Surgery (MSK02-1125.1) · effective 2025-11-15.View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-26.
Frequently asked questions
Does AIM (out-of-state / Federal BCBS) require prior authorization for Knee Arthroscopy?
Yes. AIM (out-of-state / Federal BCBS) generally requires prior authorization for Knee Arthroscopy (CPT 29875, 29876, 29877, 29879).
What does AIM (out-of-state / Federal BCBS) require to approve Knee Arthroscopy?
Prior authorization via Carelon (for participating Anthem/BCBS/FEP plans). Acute traumatic meniscal tear (repair or meniscectomy): injury within 3 months, mechanical symptoms (catching/locking/instability), at least two positive exam findings, and imaging confirming acute tear. Chronic degenerative tear: at least two exam findings, persistent mechanical symptoms OR failure of conservative manageme… Always confirm against the current AIM (out-of-state / Federal BCBS) policy.
How long does a AIM (out-of-state / Federal BCBS) prior authorization take?
Turnaround varies by plan and submission method. Check the AIM (out-of-state / Federal BCBS) portal for current timeframes.
Submitting Knee Arthroscopy to AIM (out-of-state / Federal BCBS)?
Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.