Does G0289 require prior authorization?

No, G0289 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for G0289?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 1.44.

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`G0289`, Arthroscopy, knee, surgical, for removal of loose body, foreign body,

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

1.44

Facility

N/A

Non-Facility

N/A

Documentation Required

Medicare contractors may require operative notes, reports of standing x-rays, and/or arthroscopy results to define the patient’s knee condition when adjudicating coverage.
For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.

Physician/provider is responsible for identifying patients for whom Medicare does not consider the procedure reasonable or necessary and must report appropriate procedure codes: CPT 29999 for arthroscopic lavage of the knee for OA and/or arthroscopic debridement and lavage for severe OA; CPT 29877 for arthroscopic debridement/chondroplasty for knee pain only or debridement without lavage for severe OA; HCPCS G0289 for removal of loose body/foreign body/chondroplasty at time of other surgical knee arthroscopy in a different compartment.

Key Coverage Criteria

Arthroscopic lavage or arthroscopic debridement for osteoarthritic knee in patients WITHOUT severe osteoarthritis who present with mechanical symptoms (eg, locking, snapping, popping), abnormal limb/knee alignment, or less severe/early degenerative arthritis may be considered for coverage at the discretion of the Medicare contractor.
Arthroscopic debridement (with or without partial meniscectomy) for persons presenting with mild-to-moderate (Outerbridge classification I and II, not III or IV) osteoarthritis (OA) with knee pain plus mechanical symptoms due to loose bodies and/or meniscal tears;
Arthroscopic partial meniscectomy for traumatic meniscal tears unless there is moderate or severe osteoarthritis present (Outerbridge classification III or IV);
Intra-articular glucocorticoid injections for the treatment of knee OA.
CPT/HCPCS/ICD-10 codes listed as "covered if selection criteria are met": e.g., CPT 29874 (Arthroscopy, knee, surgical; for removal of loose body or foreign body), G0289, CPTs 29880/29881 for arthroscopic partial meniscectomy, ICD-10 M17.0–M17.9 (Osteoarthritis of knee), M23.000–M23.369 (Derangement of meniscus due to old tear or injury), M25.561–M25.569 (Pain in knee), M25.661–M25.669 (Stiffness of knee), Q68.6 (Discoid meniscus) — when the CPB selection criteria are met.
Moderate-to-severe knee pain with radiographically confirmed knee OA (Kellgren-Lawrence (KL) grade II/III).

2 Active Policies

A52369, Billing and Coding: Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee Medical Policy Article

AETNA-CPB-0673, Knee Arthroscopy / Osteoarthritis of the Knee

`G0289`, Arthroscopy, knee, surgical, for removal of loose body, foreign body,

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

G0289, Arthroscopy, knee, surgical, for removal of loose body, foreign body,

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

`G0289`, Arthroscopy, knee, surgical, for removal of loose body, foreign body,