TRICARE Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair prior authorization requirements (2026)
What TRICARE generally requires to approve Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair (CPT 29914, 29915, 29916, 29860, 29861, 29862, 29863), for tricare plans. Yes. TRICARE 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 TRICARE generally applies
Prior authorization required — FAI hip surgery must be pre-authorized by the regional contractor. Covered when ALL: moderate-to-severe persistent activity-limiting hip pain worsened by flexion; exam with at least one positive test (impingement sign, FABER, or posterior-inferior impingement); failure to improve after over 3 months conservative treatment; radiographic FAI evidence; and absence of advanced arthritis (TPM Ch 4 Sec 6.1, 4.14). FAI is no longer on the TRICARE provisional-coverage list.
How to submit
- Method: Humana Military self-service
- Portal: Humana Military
Sources & verification
- BindingSource — TRICARE Policy Manual 6010.60-M, Ch 4 Sec 6.1 (Musculoskeletal, 4.14 FAI) · effective 2024-07-16.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 TRICARE require prior authorization for Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
Yes. TRICARE generally requires prior authorization for Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair (CPT 29914, 29915, 29916, 29860, 29861, 29862, 29863).
What does TRICARE require to approve Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair?
Prior authorization required — FAI hip surgery must be pre-authorized by the regional contractor. Covered when ALL: moderate-to-severe persistent activity-limiting hip pain worsened by flexion; exam with at least one positive test (impingement sign, FABER, or posterior-inferior impingement); failure to improve after over 3 months conservative treatment; radiographic FAI evidence; and absence of ad… Always confirm against the current TRICARE policy.
How long does a TRICARE prior authorization take?
Turnaround varies by plan and submission method. Check the TRICARE portal for current timeframes.
Submitting Arthroscopic Hip Surgery for Impingement Syndrome Including Labral Repair to TRICARE?
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.