Harvard Pilgrim has reviewed and updated our Knee Arthroscopy Medical Review Criteria to make it consistent with the latest published medical evidence and with the policies of other regional health plans.
Effective January 15, 2014, for our commercial HMO/PPO/POS products, Harvard Pilgrim will continue to require a prior authorization for all in-network knee arthroscopy procedures and will begin requiring more robust documentation of prior treatment. Harvard Pilgrim may require documentation confirming failure of conservative management measures (such as physical therapy or the use of anti-inflammatory medications such as NSAIDS), unless contraindicated.
The prior authorization criteria for knee arthroscopy vary by condition. For detailed information on prior authorization criteria by condition (such as intra-articular joint pathology, acute meniscal tear, or reconstruction of the ACL), please review the updated Knee Arthroscopy Medical Review Criteria.