Oscar Health Knee Meniscectomy prior authorization requirements (2026)
What Oscar Health generally requires to approve Knee Meniscectomy (CPT 29880, 29881, 29882, 29883), for commercial plans. Yes. Oscar Health generally requires prior authorization for Knee Meniscectomy (CPT 29880, 29881, 29882, 29883).
Medical-necessity criteria Oscar Health generally applies
Prior authorization required via eviCore (CMM-312 Knee Surgery, Arthroscopic and Open). Meniscectomy/repair medically necessary when MRI/CT-arthrogram shows a meniscal tear extending to the articular surface correlating with symptoms, absence of Kellgren-Lawrence Grade II or greater OA (waived for locked knee), at least two positive exam findings (limited ROM, effusion, joint-line tenderness, McMurray, Thessaly, Apley), function-limiting symptoms, and at least 3 months failed non-surgical management (waived for locked knee/acute displaced tear).
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Knee Meniscectomy. Confirm the covered diagnosis list against the current Oscar Health policy.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — eviCore CMM-312 Knee Surgery — Arthroscopic and Open Procedures (CMM-312) · 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 Knee Meniscectomy?
Yes. Oscar Health generally requires prior authorization for Knee Meniscectomy (CPT 29880, 29881, 29882, 29883).
What does Oscar Health require to approve Knee Meniscectomy?
Prior authorization required via eviCore (CMM-312 Knee Surgery, Arthroscopic and Open). Meniscectomy/repair medically necessary when MRI/CT-arthrogram shows a meniscal tear extending to the articular surface correlating with symptoms, absence of Kellgren-Lawrence Grade II or greater OA (waived for locked knee), at least two positive exam findings (limited ROM, effusion, joint-line tenderness, McMu… 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 Meniscectomy 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.