Utilization Review Checklist
Hamstring and Hip Flexor Strains
Derived from the ACOEM Hip and Groin Disorders Guideline, edition 29 January 2026, as adopted into the California MTUS 1 August 2026. CPT 27385, 27386. ICD-10 S76.3, S76.1.
Draft — not reviewed or approved by COA. Prepared by Rette from the ACOEM guideline named above. This is not a COA document and does not reproduce COA’s own checklists.
CriteriaCheck if documented
Confirmatory Diagnosis
All of the following
Large or complete tear of the hamstrings or hip flexors
“Indications Large or complete tears of the hamstrings or hip flexor strains with functional deficits felt amenable to surgical treatment.” — p. 274
AND
Functional deficits felt amenable to surgical treatment
“Large or complete tears of the hamstrings or hip flexor strains with functional deficits felt amenable to surgical treatment.” — p. 274
Surgical Considerations (surgical repair)
Required
Repair requested for a large or complete tear
“Generally, large or complete hamstrings tears require surgical repair to facilitate recovery.” — p. 274
Procedures — the guideline treats each separately
Surgical repair of large or complete hamstring or hip flexor strains
Recommended.
Strength of Evidence — Recommended, Insufficient Evidence (I) · confidence high
High confidence, and the guideline goes further than most: 'Generally, large or complete hamstrings tears require surgical repair to facilitate recovery.' There is no conservative-care requirement stated. What carries the request is the SIZE of the tear — large or complete — so the imaging report is the document that matters.