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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Total hip resurfacing (HR) is proposed as a bone-conserving alternative to the total hip arthroplasty (THA) to treat severe degenerative diseases of the hip. Modern total HR components consist of high-carbide cobalt chrome metal-on-metal (MoM) bearings that articulate against an intermediate synovial fluid film, a design that results in low surface wear. Recently the data from national total joint registries as well as peer-reviewed journal publications and presentations at scientific meetings have suggested increasing rates of potential safety issues associated with the MoM hip resurfacing procedure.
The State Health Technology Clinical Committee (HTCC) re-reviewed hip resurfacing on November 15, 2013. The committee’s determination, based on a systematic review of the evidence of safety, efficacy and cost-effectiveness, is that hip resurfacing is not a covered benefit. Complete information on this HTCC determination is available here: What we're working on | Washington State Health Care Authority.
ICD codes: 00.85, 00.86 and 00.87
CPT© code: 27299
HCPCS code: S2118