AIM (out-of-state / Federal BCBS) Knee Meniscectomy prior authorization requirements (2026)
What AIM (out-of-state / Federal BCBS) generally requires to approve Knee Meniscectomy (CPT 29880, 29881, 29882, 29883), for commercial plans. Yes. AIM (out-of-state / Federal BCBS) generally requires prior authorization for Knee Meniscectomy (CPT 29880, 29881, 29882, 29883).
Medical-necessity criteria AIM (out-of-state / Federal BCBS) generally applies
Prior authorization via Carelon (Joint Surgery MSK02-1125.1). Acute traumatic tear (injury under 3 months): functional pain plus mechanical symptoms plus meniscus-consistent exam plus imaging showing an acute tear pattern — no conservative-care wait. Chronic degenerative tear: meniscus-consistent exam plus persistent mechanical symptoms OR at least 12 weeks failed conservative management, plus matching imaging, plus no more than moderate OA.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Knee Meniscectomy. 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 Meniscectomy?
Yes. AIM (out-of-state / Federal BCBS) generally requires prior authorization for Knee Meniscectomy (CPT 29880, 29881, 29882, 29883).
What does AIM (out-of-state / Federal BCBS) require to approve Knee Meniscectomy?
Prior authorization via Carelon (Joint Surgery MSK02-1125.1). Acute traumatic tear (injury under 3 months): functional pain plus mechanical symptoms plus meniscus-consistent exam plus imaging showing an acute tear pattern — no conservative-care wait. Chronic degenerative tear: meniscus-consistent exam plus persistent mechanical symptoms OR at least 12 weeks failed conservative management, plus mat… 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 Meniscectomy 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.