Anthem/Elevance Health Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair prior authorization requirements (2026)
What Anthem/Elevance Health generally requires to approve Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair (CPT 29914, 29915, 29916, 29860, 29861, 29862, 29863), for Commercial plans. Yes. Anthem/Elevance Health generally requires prior authorization for Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair (CPT 29914, 29915, 29916, 29860, 29861, 29862, 29863).
Medical-necessity criteria Anthem/Elevance Health generally applies
(1) MRI or MR arthrogram confirming FAI (alpha angle >55°) with labral or chondral pathology; (2) Symptoms ≥3 months; positive FADIR; (3) PT failure ≥3 months (≥8 sessions, hip-specific protocol); (4) Tönnis Grade ≤1 or K-L ≤2 on imaging; (5) HOS or iHOT-33 in severe range
Commonly required documentation
- MRI/MR arthrogram
- alpha angle measurement
- PT records
- HOS/iHOT score
- standing pelvis and lateral hip X-rays
- surgeon evaluation
How to submit
- Portal: Availity / Anthem Provider Portal
- Typical turnaround: about 3 days
Source
K-L Grade 2+ hip arthritis is high risk for denial. Alpha angle must be explicitly measured and documented in radiology or surgical note.
Frequently asked questions
Does Anthem/Elevance Health require prior authorization for Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
Yes. Anthem/Elevance Health generally requires prior authorization for Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair (CPT 29914, 29915, 29916, 29860, 29861, 29862, 29863).
What does Anthem/Elevance Health require to approve Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
(1) MRI or MR arthrogram confirming FAI (alpha angle >55°) with labral or chondral pathology; (2) Symptoms ≥3 months; positive FADIR; (3) PT failure ≥3 months (≥8 sessions, hip-specific protocol); (4) Tönnis Grade ≤1 or K-L ≤2 on imaging; (5) HOS or iHOT-33 in severe range Always confirm against the current Anthem/Elevance Health policy.
How long does a Anthem/Elevance Health prior authorization take?
Anthem/Elevance Health typically decides Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair requests in about 3 days. Timeframes vary; check the payer portal.
Submitting Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair to Anthem/Elevance Health?
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.