QualCare Knee Meniscectomy prior authorization requirements (2026)
What QualCare generally requires to approve Knee Meniscectomy (CPT 29880, 29881, 29882, 29883), for commercial plans. Yes. QualCare generally requires prior authorization for Knee Meniscectomy (CPT 29880, 29881, 29882, 29883).
Medical-necessity criteria QualCare generally applies
Prior authorization via eviCore (Cigna CMM-312). Meniscectomy/repair medically necessary when MRI/CT-arthrogram shows an articular-surface meniscal tear correlating with symptoms, absence of Kellgren-Lawrence Grade II or greater OA (waived for locked knee), at least two positive exam findings, function-limiting symptoms, and at least 3 months failed non-surgical management.
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 QualCare policy.
How to submit
- Method: eviCore portal
- Portal: eviCore by Evernorth (Cigna MSK/Spine)
Sources & verification
- BindingSource — Cigna 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 QualCare require prior authorization for Knee Meniscectomy?
Yes. QualCare generally requires prior authorization for Knee Meniscectomy (CPT 29880, 29881, 29882, 29883).
What does QualCare require to approve Knee Meniscectomy?
Prior authorization via eviCore (Cigna CMM-312). Meniscectomy/repair medically necessary when MRI/CT-arthrogram shows an articular-surface meniscal tear correlating with symptoms, absence of Kellgren-Lawrence Grade II or greater OA (waived for locked knee), at least two positive exam findings, function-limiting symptoms, and at least 3 months failed non-surgical management. 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 Knee Meniscectomy 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.