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).
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.
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
- Portal: Availity / Anthem Provider Portal
- Typical turnaround: about 2 days
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.