Does S2118 require prior authorization?

Yes, S2118 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for S2118?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

HCPCS/CPT S2118, Metal-on-metal total hip resurfacing, including acetabular and femoral | Prior Auth Required

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`S2118`, Metal-on-metal total hip resurfacing, including acetabular and femoral

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Computed tomography scanning may be performed to assess post-operative complaints for metal talar inlay implants (Vuurberg et al. 2018: CT scanning used in 8 patients to assess post-operative complaints).

Clinical and functional outcome documentation used in studies (examples): Oxford Shoulder Score, Constant-Murley Score, Numeric Rating Scales (NRS) for pain, FAOS, AOFAS Ankle-Hindfoot Scale, SF-36, WOMAC, KSS, OKS, Forgotten Joint Score — these outcome measures were consistently collected in the literature though not explicitly mandated as coverage documentation in this excerpt.

No documentation requirements, required medical records, test results, or specific clinical documentation items are specified in this excerpt.

"pre-operative CT scans" used for CT-based 3D implant planning and templating in robotic-assisted TKA (eg, "All cases undergoing RA-TKA undergo pre-operative CT-scans as per protocol.")

Medical record must clearly document history of unsuccessful conservative therapy, or if conservative therapy is not appropriate, why such approach is not reasonable.

Documentation of at least 12 weeks of non-surgical treatment in the medical record, including all of the following unless contraindicated: anti-inflammatory medications or analgesics; flexibility and muscle strengthening exercises; activity modification; supervised physical therapy (ADLs diminished despite completing a plan of care); weight reduction as appropriate; assistive device use where appropriate; therapeutic injections into the hip where appropriate.

Key Coverage Criteria

Coverage requires that surgery of the hip/FAI syndrome is medically necessary in specific circumstances as defined by the InterQual CP criteria referenced by UnitedHealthcare; treatment is not universally covered for all FAI cases.
anatomic patellofemoral inlay resurfacing
UniCAP as an alternative for unicompartmental arthritis
robotic-arm assisted total knee arthroplasty
patellar resurfacing after total knee arthroplasty
prosthetic inlay resurfacing as a salvage procedure for a failed cartilage repair

10 Active Policies

EVICORE-HPLAN-THE_HEALTH_PLAN-9B57580E1B4F, The Health Plan MSK Joint Code List - Effective 01/01/2026

CARELON-joint-surgery-2024-11-17-updated-2025-01-01, Joint Surgery

CARELON-joint-surgery-2025-11-15, Joint Surgery

UHC-POL-surgery-hip, Surgery of the Hip

AETNA-CPB-0661, Joint Resurfacing

BCBSIL-SUR705.019, Hip Resurfacing

BCBSMT-SUR705.019, Hip Resurfacing

BCBSNM-SUR705.019, Hip Resurfacing

BCBSOK-SUR705.019, Hip Resurfacing

UMR-POL-UMR-surgery-hip, Surgery of the Hip

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S2118, Metal-on-metal total hip resurfacing, including acetabular and femoral