Oscar Health Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair prior authorization requirements (2026)
What Oscar 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. Oscar 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 Oscar Health generally applies
Prior authorization required via eviCore (CMM-314 Hip Surgery). FAI surgery medically necessary when imaging confirms FAI (alpha angle over 50 degrees, pistol-grip deformity, decreased head-neck offset, acetabular retroversion, or coxa profunda) AND Tonnis Grade 0-1, exam shows a positive anterior impingement sign AND limited passive internal rotation, and at least 3 months failed non-surgical management including an image-guided intra-articular hip injection with positive response. Labral repair: conclusive labral imaging plus Tonnis 0-1 plus a positive provocative test plus mechanical symptoms plus the same conservative/injection requirement. Excluded if Tonnis 2-3.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — eviCore CMM-314 Hip Surgery — Arthroscopic and Open Procedures (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 Oscar Health require prior authorization for Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
Yes. Oscar 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 Oscar Health require to approve Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
Prior authorization required via eviCore (CMM-314 Hip Surgery). FAI surgery medically necessary when imaging confirms FAI (alpha angle over 50 degrees, pistol-grip deformity, decreased head-neck offset, acetabular retroversion, or coxa profunda) AND Tonnis Grade 0-1, exam shows a positive anterior impingement sign AND limited passive internal rotation, and at least 3 months failed non-surgical man… Always confirm against the current Oscar Health policy.
How long does a Oscar Health prior authorization take?
Turnaround varies by plan and submission method. Check the Oscar Health portal for current timeframes.
Submitting Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair to Oscar 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.