Anthem/Elevance Health Knee Arthroscopy prior authorization requirements (2026)

What Anthem/Elevance Health generally requires to approve Knee Arthroscopy (CPT 29875, 29876, 29877, 29879), for Commercial plans. Yes. Anthem/Elevance Health generally requires prior authorization for Knee Arthroscopy (CPT 29875, 29876, 29877, 29879).

General reference compiled from public sources. This is not a coverage determination or medical advice. Always confirm current requirements with Anthem/Elevance Health before submitting.

Medical-necessity criteria Anthem/Elevance Health generally applies

Not approved for degenerative meniscal tears or OA. Approved only for: (1) Mechanically locked knee (displaced bucket-handle tear); (2) Symptomatic loose body with mechanical symptoms; (3) Septic joint washout. Document mechanical indication explicitly — degenerative arthroscopy is non-covered per Anthem clinical policy.

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 Anthem/Elevance Health policy.

M23.209Derangement of unspecified meniscus due to old tear or injury, unspecified knee

Commonly required documentation

  • MRI confirming displaced tear or mechanical pathology
  • clinical documentation of true locking
  • surgeon note addressing mechanical vs. degenerative nature

How to submit

Source

Anthem follows AAOS evidence-based guidelines — degenerative knee arthroscopy is non-covered. Peer-to-peer available but outcome unlikely to change for purely degenerative indications.

Frequently asked questions

Does Anthem/Elevance Health require prior authorization for Knee Arthroscopy?

Yes. Anthem/Elevance Health generally requires prior authorization for Knee Arthroscopy (CPT 29875, 29876, 29877, 29879).

What does Anthem/Elevance Health require to approve Knee Arthroscopy?

Not approved for degenerative meniscal tears or OA. Approved only for: (1) Mechanically locked knee (displaced bucket-handle tear); (2) Symptomatic loose body with mechanical symptoms; (3) Septic joint washout. Document mechanical indication explicitly — degenerative arthroscopy is non-covered per Anthem clinical policy. Always confirm against the current Anthem/Elevance Health policy.

How long does a Anthem/Elevance Health prior authorization take?

Anthem/Elevance Health typically decides Knee Arthroscopy requests in about 2 days. Timeframes vary; check the payer portal.

Submitting Knee Arthroscopy 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.

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Other Anthem/Elevance Health prior authorization requirements

Anterior Cervical Discectomy and FusionArthroscopic Hip Surgery for Impingement Syndrome Including Labral RepairCarpal Tunnel SurgeryCT Abdomen and Pelvis with contrastCTA Chest (e.g., pulmonary embolism)Dorsal Column (Lumbar) Neurostimulators: Trial or ImplantationKnee MeniscectomyLumbar Spinal FusionMRI Brain without contrastMRI Cervical Spine without contrastMRI Lower Extremity Joint without contrastMRI Lumbar Spine without contrast

Related guides

Why was my prior authorization denied? Top reasons and how to fix eachHow to write a prior authorization appeal that cites policy