Utilization Review Checklist
Carpometacarpal (CMC) / Basilar Thumb Joint Arthrosis
Derived from the ACOEM Hand, Wrist and Forearm Disorders Guideline, edition 14 July 2025, as adopted into the California MTUS 2 January 2026. CPT 25447, 25445, 25440. ICD-10 M18.
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
Presumptive Diagnosis
All of the following
Pain at the base of the thumb with gripping and pinching
“● pain at the base of the thumb with gripping and pinching,” — p. 328
AND
Tenderness at the base of the thumb joint
“● tenderness at the base of the thumb joint,” — p. 328
AND
Pain with compression and/or grind at the base of the thumb joint
“● pain with compression and/or grind at the base of the thumb joint and” — p. 328
AND
Symptoms that interfere with activities of daily living and/or work
“● symptoms that interfere with activities of daily living and/or work.” — p. 328
Confirmatory Diagnosis
Required
X-rays with degenerative changes at the base of the thumb (first CMC/basilar joint/trapeziometacarpal joint)
“A confirmatory diagnosis requires the addition of x-rays with degenerative changes at the base of the thumb (first CMC/basilar joint/trapeziometacarpal joint).” — p. 328
Conservative Care
Required
Failure of a minimum of 6 weeks of nonoperative treatments — at least 6 weeks
“Surgical considerations include the failure of a minimum of 6 weeks of nonoperative treatments.” — p. 328
Surgical Considerations (procedure per surgeon's preference)
Required
One of trapeziectomy, trapeziectomy with ligament reconstruction and tendon interposition (LRTI), or fusion of the CMC joint, based on surgeon's preference and judgment
“One of the following procedures is indicated based on surgeon's preference and judgment: ● trapeziectomy, ● trapeziectomy with ligament reconstruction and tendon interposition (LRTI), and ● fusion of the CMC joint.” — p. 328
Procedures — the guideline treats each separately
Reconstructive surgery for trapeziometacarpal arthrosis
Recommended.
Strength of Evidence — Recommended, Evidence (C) · confidence low
The guideline leaves the choice among trapeziectomy, trapeziectomy with ligament reconstruction and tendon interposition, and CMC fusion to the surgeon's preference and judgment, so the procedure chosen is not itself a ground for denial. It does note that LRTI is not superior to simple trapeziectomy on most measures and carries roughly twice the complication rate — expect that to be raised, and give your reason if LRTI is what you intend. The conservative-care threshold here is only six WEEKS.