Humana Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair prior authorization requirements (2026)
What Humana 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. Humana 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 Humana generally applies
Patient must meet ALL: (1) MRI or MR arthrogram confirming FAI (alpha angle >55° or lateral CE angle >40°) with labral tear or chondral pathology; (2) Symptoms ≥3 months, positive FADIR, limited internal rotation; (3) Failure of ≥3 months hip-specific PT (≥8 sessions) and NSAID trial; (4) No significant arthritis (Tönnis Grade ≤1 or K-L ≤2); (5) HOS or iHOT-33 score in severe range
Commonly required documentation
- MRI/MR arthrogram with alpha angle measurements
- PT records ≥8 sessions
- HOS/iHOT score
- standing AP pelvis and lateral hip X-rays
- surgeon evaluation
- exam findings (FADIR, ROM)
How to submit
- Portal: Humana Provider Portal / Availity
- Typical turnaround: about 3 days
Source
High denial risk with K-L Grade 2 hip arthritis. Request peer-to-peer proactively. HOS score required — collect at surgical consultation.
Frequently asked questions
Does Humana require prior authorization for Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
Yes. Humana generally requires prior authorization for Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair (CPT 29914, 29915, 29916, 29860, 29861, 29862, 29863).
What does Humana require to approve Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
Patient must meet ALL: (1) MRI or MR arthrogram confirming FAI (alpha angle >55° or lateral CE angle >40°) with labral tear or chondral pathology; (2) Symptoms ≥3 months, positive FADIR, limited internal rotation; (3) Failure of ≥3 months hip-specific PT (≥8 sessions) and NSAID trial; (4) No significant arthritis (Tönnis Grade ≤1 or K-L ≤2); (5) HOS or iHOT-33 score in severe range Always confirm against the current Humana policy.
How long does a Humana prior authorization take?
Humana 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 Humana?
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.