Clover Health Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair prior authorization requirements (2026)
What Clover Health generally requires to approve Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair (CPT 29914, 29915, 29916, 29860, 29861, 29862, 29863), for medicare_advantage plans. Yes. Clover 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 Clover Health generally applies
Prior authorization required via eviCore (CMM-314, same FAI/labral criteria: alpha angle over 50 degrees, Tonnis 0-1, positive impingement plus limited internal rotation, at least 3 months conservative care including a positive diagnostic injection). Medicare note: there is no NCD or LCD governing hip arthroscopy/FAI, so eviCore criteria control.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — eviCore CMM-314 Hip Surgery (no NCD/LCD governs hip arthroscopy/FAI) (CMM-314) · effective 2025-07-01.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 Clover Health require prior authorization for Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
Yes. Clover 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 Clover Health require to approve Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
Prior authorization required via eviCore (CMM-314, same FAI/labral criteria: alpha angle over 50 degrees, Tonnis 0-1, positive impingement plus limited internal rotation, at least 3 months conservative care including a positive diagnostic injection). Medicare note: there is no NCD or LCD governing hip arthroscopy/FAI, so eviCore criteria control. Always confirm against the current Clover Health policy.
How long does a Clover Health prior authorization take?
Turnaround varies by plan and submission method. Check the Clover Health portal for current timeframes.
Submitting Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair to Clover 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.