Coverage of Conditions and Treatments (Coverage Decisions)
Use this lookup tool to determine coverage decisions, or if prior authorization is needed for the treatment or condition. Note: For Self-insured employer claims, you must contact the employer or their claims administrator.
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See Treatment Guidelines and Resources for additional information.
Last reviewed and confirmed: May 2020
Femoroacetabular impingement (FAI) syndrome is a diagnosis in primarily younger individuals where relatively minor abnormalities in the joint (orientation or morphology) are thought to cause friction/impingement and pain. Surgical correction of the impinging deformities is believed to alleviate the symptoms and retard the progression of osteoarthritis degeneration. Hip surgery is an invasive procedure to correct FAI using either an open surgery or arthroscopic approach.
The decision is based on the recent Health Technology Clinical Committee (HTCC) coverage determination (re-review) finalized in January 2020. The initial review occurred in 2011 and the HTCC determined that hip surgery for FAI syndrome was not a covered benefit. The committee reviewed the new evidence on the hip surgery in late 2019 and voted again to not cover hip surgery for FAI syndrome. Complete information on this HTCC determination is available here:
What we're working on | Washington State Health Care Authority
In adopting this HTCC coverage determination, the Department has concluded that the determination does not conflict with any state statute. Any coverage for investigational treatment would be considered per WAC 296-20-02850. Any coverage for health technologies that have a FDA Humanitarian Device Exemption status would be considered per RCW 70.14.120 (1) (b).