Medicare Coverage Database |
Content Section
| Issue |
Osteoarthritis of the knee is a degenerative joint disease that affects a large number of Medicare beneficiaries. It is a chronic disease characterized by pain and inflammation that frequently requires medical and/or surgical intervention.
Arthoscopy involves direct visualization of the joint by a fiber-optic viewing instrument. Arthroscopic lavage and debridement is often recommended when medical therapy fails to relieve osteoarthritic knee pain. Recent evidence published in the New England Journal of Medicine (N Engl J Med Vol 347, No. 2, 2002) suggests that arthroscopic lavage and/or debridement in patients with osteoarthritis of the knee without other specific indications is no better than placebo surgery.
CMS will evaluate the scientific evidence to determine the indications for which arthroscopic lavage and/or debridement for the treatment of the osteoarthritic knee is reasonable and necessary.
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| National Coverage Determination(s) |
| 150.9
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| Benefit Category |
| Incident to a physician's professional Service, Inpatient Hospital Services, Physicians' Services |
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| Requestor Name(s) |
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Internally generated | | |
| Formal Request Accepted and Review Initiated |
| 10/10/2002 |
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| Expected NCA Completion Date |
| 7/3/2003 |
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| Decision Memo Released |
| 7/3/2003 |
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| Lead Analyst(s) |
Anthony Norris
Niccole Corbin
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| Lead Medical Officer(s) |
Shamiram Feinglass, MD, MPH
Lawrence Schott, MD, MS
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| Actions Taken |
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October 9, 2002
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Tracking sheet posted.
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| December 9, 2002 |
CMS met with representatives from the American Academy of Orthopaedic Surgeons (AAOS), American Association of Hip and Knee Surgeons/Knee Society (AAHKS), American Orthopaedic Society of Sports Medicine (AAOSSM), and Arthroscopy Association of North America (AANA) on November 25, 2002, to discuss the appropriate indications for arthroscopy of the osteoarthritic knee.
At the conclusion of this meeting, the AAOS and other specialty societies agreed to provide additional information detailing the specific appropriate indications for arthroscopic surgery for the osteoarthritic knee, including the scientific evidence and clinical rationale supporting each of these indications.
The due date of this request will be extended to allow time for these groups to provide this information. [date entered in Expected Completion Date field is an approximation]
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| February 21, 2003 |
CMS met with AAOS senior staff and clinicians on January 30, 2003, to discuss the report “Arthroscopic Surgery and Osteoarthritis of the Knee” [PDF, 71KB] submitted on behalf of the AAOS, AAHKS, AOSSM, and AANA to CMS on January 20, 2003. The final electronic version, received by CMS on February 4, 2003, is posted for comment. |
| April 2, 2003 |
CMS is extending the due date 60 days to allow additional time for internal review.
The Center for Medicare Management has determined that arthroscopy for the treatment of the osteoarthritic knee falls within the benefit category set forth in section 1861(b)(3) (inpatient hospital services), 1861(s)(1) (physician services), or 1861 (s)(2)(B) (hospital services “incident to” physicians' services rendered to outpatients) of the Social Security Act.
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| June 20, 2003 |
CMS is extending the due date to July 1, 2003 to allow additional time for internal review. |
| July 3, 2003 |
Decision Memorandum posted. |
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