Arthroscopic Knee Washout for Patients with Osteoarthritis

Last updated date

July 2024

Review date

Mar 2028

Prior Approval Required

Not Applicable

Bunion (Hallux Valgus) Correction Surgery

Last updated date

July 2024

Review date

Apr 2026

Prior Approval Required

Not Applicable

Carpal Tunnel Syndrome

Last updated date

Sept 2024

Review date

June 2025

Prior Approval Required

Not Applicable

Diagnostic Knee Arthroscopy

Last updated date

Apr 2022

Review date

Mar 2028

Prior Approval Required

Not Applicable

Dupuytren's Contracture

Last updated date

Sept 2024

Review date

Sept 2025

Prior Approval Required

Not Applicable

Ganglion Cysts

Last updated date

Oct 2021

Review date

Sept 2027

Prior Approval Required

Not Applicable

Hip and Knee Replacement

Last updated date

Sept 2024

Review date

Jan 2028

Prior Approval Required

Not Applicable

Injections for Isolated Lower Back Pain without Sciatica

Last updated date

Feb 2025

Review date

Jan 2028

Prior Approval Required

Not Applicable

Knee MRI for suspected meniscal tears

Last updated date

Mar 2025

Review date

Feb 2025

Prior Approval Required

Not Applicable

Knee MRI when symptoms are suggestive of osteoarthritis

Last updated date

Mar 2025

Review date

Feb 2028

Prior Approval Required

Not Applicable

Low Back Pain Imaging

Last updated date

Oct 2022

Review date

Sept 2025

Prior Approval Required

Not Applicable

Spinal Decompression for Sciatica

Last updated date

June 2021

Review date

May 2027

Prior Approval Required

Not Applicable

Trigger Finger

Last updated date

Nov 2021

Review date

Oct 2027

Prior Approval Required

Not Applicable

Use of Imaging in the Management of Morton's Neuroma Position Statement

Last updated date

Dec 2022

Review date

Nov 2025

Prior Approval Required

Not Applicable

Use of Imaging in the Management of Trochanteric Bursitis/Greater Trochanteric Pain Syndrome (GTPS) Position Statement

Last updated date

Dec 2022

Review date

Nov 2025

Prior Approval Required

Not Applicable