Medicare AdvantageCoverageMedium impact
MA11.093a, Surgical Treatments of Athletic Pubalgia
Independence Blue Cross·Orthopedics, Sports Medicine, General Surgery·Medical Policy
Effective date
Jul 9, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA11.093a covering surgical treatments for athletic pubalgia (sports hernia) has been reissued effective July 9, 2025. This policy update affects coverage criteria and potentially prior authorization requirements for surgical procedures treating groin pain in athletes.
Action Required
By July 9, 2025: Billing team should review the complete MA11.093a policy at the provided URL to identify specific coverage criteria, prior authorization requirements, and billing guidelines for athletic pubalgia surgical procedures. Update billing protocols and inform orthopedic and sports medicine providers of any new documentation or approval requirements for Medicare Advantage patients.