Hello...needing some advice...I thought I would continue here as it has a lot of previous questions and answers. Here goes..
My son was planning to have his surgery done by a civilian physician to repair a labral tear arthoscopically through Tricare Prime. My son saw the civilian doctor in May, 2011 and surgery was schedule for late July, 2011. Tricare had denied his surgery as unproven/expermental twice under CPT codes 29862 (Treatment of FAI and debridement of articular cartilage) and 29916 (Hip Arthoscopy to repair Labral tear). We have the option to appeal...however it seems that is a long drawn out process. He is currently TDRL Navy and he received 10% for his hip labral tear and 20% for his back condition.
He hasn't received his rating yet for the VA, but he does have a VA PCM that he has seen twice.
So here's the big question...does anyone know what the procedure would be to go through the VA for the surgery. Should he see his VA PCM and ask for an orthopedic referral or can he ask his VA PCM directly for a referral to his civilian orthopedic who does arthoscopic surgery? Does the VA even have doctors that perform hip arthoscopic surgery? Then the next question is...does the VA call the surgery he needs unproven/ expermental? I have read on other forums that there have been some active duty dependents that have had this surgery through a military treatment facility and also there are active duty military that are having their surgeries approved using civilian doctors under CPT code 29862 through Tricare. I really don't get why some are approved and others are not under the Tricare system. I realize this is a VA forum, but I was wondering if anyone has had any experience in the area...Tricare or VA.
Any help you could give would be greatly appreciated.