Oscar Health Knee Arthroscopy prior authorization requirements (2026)
What Oscar Health generally requires to approve Knee Arthroscopy (CPT 29875, 29876, 29877, 29879), for commercial plans. Yes. Oscar Health generally requires prior authorization for Knee Arthroscopy (CPT 29875, 29876, 29877, 29879).
Medical-necessity criteria Oscar Health generally applies
Prior authorization required via eviCore (CMM-312 Knee Surgery, Arthroscopic and Open). Conservative-care documentation expected. PA applies in Oscar service-area states incl. NJ/NY.
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 Oscar Health policy.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — Oscar — eviCore Musculoskeletal/Spine/Pain program.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 2026-06-25.
Frequently asked questions
Does Oscar Health require prior authorization for Knee Arthroscopy?
Yes. Oscar Health generally requires prior authorization for Knee Arthroscopy (CPT 29875, 29876, 29877, 29879).
What does Oscar Health require to approve Knee Arthroscopy?
Prior authorization required via eviCore (CMM-312 Knee Surgery, Arthroscopic and Open). Conservative-care documentation expected. PA applies in Oscar service-area states incl. NJ/NY. 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 Knee Arthroscopy 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.