August 2003 AAOS Report

AAOS leads response to CMS national coverage determination announcement

The Centers for Medicare and services (CMS) announced its intent to issue a national noncoverage determination on arthroscopy for osteoarthritis of the knee (OA Knee). The determination, which was developed in close cooperation with AAOS and other orthopaedic groups, indicated that arthroscopic lavage alone is not reasonable and necessary for patients with OA Knee, nor is arthroscopic debridement reasonable and necessary for patients presenting with knee pain only or with severe OA Knee. This is the position the orthopaedic community, as represented by the AAOS, the American Association of Hip and Knee Surgeons, the Knee Society, the American Orthopaedic Society of Sports Medicine and the Arthroscopy Association of America. However, the decision did raise some concerns. There are problems with the classification system adopted by CMS when it is used to determine the severity of arthritis. In addition, there are concerns about the potential confusion in implementing the decision.
During a teleconference call on August 8, representatives from the above-mentioned groups agreed it was necessary to continue to work with CMS on this coverage issue and discussed the next steps in the process: 1) Send a memo to CMS outlining the orthopaedic community's concerns and possible solutions to the perceived problems; 2) Request a face-to-face meeting with CMS to discuss the concerns; and 3) Keep the orthopaedic community informed of developments as they occur.


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