QualCare Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair prior authorization requirements (2026)
What QualCare 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. QualCare 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 QualCare generally applies
Prior authorization via eviCore (Cigna CMM-314). FAI: imaging confirmation (alpha angle over 50 degrees / pistol-grip / decreased head-neck offset / acetabular retroversion / coxa profunda) AND Tonnis 0-1; exam positive anterior impingement sign plus limited passive internal rotation; at least 3 months non-surgical management including an image-guided intra-articular injection with positive response. Excluded for Tonnis 2-3.
How to submit
- Method: eviCore portal
- Portal: eviCore by Evernorth (Cigna MSK/Spine)
Sources & verification
- BindingSource — Cigna CMM-314 Hip Surgery — Arthroscopic and Open Procedures (CMM-314) · effective 2026-03-07.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 QualCare require prior authorization for Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
Yes. QualCare generally requires prior authorization for Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair (CPT 29914, 29915, 29916, 29860, 29861, 29862, 29863).
What does QualCare require to approve Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
Prior authorization via eviCore (Cigna CMM-314). FAI: imaging confirmation (alpha angle over 50 degrees / pistol-grip / decreased head-neck offset / acetabular retroversion / coxa profunda) AND Tonnis 0-1; exam positive anterior impingement sign plus limited passive internal rotation; at least 3 months non-surgical management including an image-guided intra-articular injection with positive respon… Always confirm against the current QualCare policy.
How long does a QualCare prior authorization take?
Turnaround varies by plan and submission method. Check the QualCare portal for current timeframes.
Submitting Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair to QualCare?
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.