TRICARE Knee Arthroscopy prior authorization requirements (2026)
What TRICARE generally requires to approve Knee Arthroscopy (CPT 29875, 29876, 29877, 29879), for tricare plans. Based on the cited policy, TRICARE does not generally require prior authorization for Knee Arthroscopy (CPT 29875, 29876, 29877, 29879). Confirm with TRICARE, as this can vary by plan.
Medical-necessity criteria TRICARE generally applies
No mandatory Humana Military prior authorization (not on the PA list); TRICARE Prime requires a PCM referral to the specialist and inpatient admission requires notification. Covered when medically necessary (TRICARE Policy Manual 6010.60-M, Ch 4 Section 6.1).
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 TRICARE policy.
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) · effective 2022-05-24.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 TRICARE require prior authorization for Knee Arthroscopy?
Based on the cited policy, TRICARE does not generally require prior authorization for Knee Arthroscopy (CPT 29875, 29876, 29877, 29879). Confirm with TRICARE, as this can vary by plan.
What does TRICARE require to approve Knee Arthroscopy?
No mandatory Humana Military prior authorization (not on the PA list); TRICARE Prime requires a PCM referral to the specialist and inpatient admission requires notification. Covered when medically necessary (TRICARE Policy Manual 6010.60-M, Ch 4 Section 6.1). 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 Knee Arthroscopy 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.