Draft — pending COA review. Rette derived these criteria from the ACOEM guidelines adopted into the MTUS. They are not COA documents and have not been signed off by a COA physician reviewer.

MTUS Treatment ChecklistbyRette

Utilization Review Checklist

Hip Fracture

Derived from the ACOEM Hip and Groin Disorders Guideline, edition 29 January 2026, as adopted into the California MTUS 1 August 2026. CPT 27235, 27236, 27244, 27245. ICD-10 S72.0, S72.1.

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.

Patient name: Claim #:

CriteriaCheck if documented

Confirmatory Diagnosis

Required

  • Hip fracture confirmed on imaging

    “Indications Hip fractures.” — p. 225

Surgical Considerations (surgical treatment)

All of the following

  • Surgery as soon as the patient is medically stable

    “Surgical intervention for hip fractures is recommended as soon as the patient is medically stable.” — p. 225

  • AND

    Procedure selected for the fracture pattern

    “Surgical intervention for hip fractures is recommended as soon as the patient is medically stable.” — p. 225

Procedures — the guideline treats each separately

Surgical treatment for hip fracture

Recommended.

Strength of Evidence — Recommended, Insufficient Evidence (I) · confidence high

The shortest indication in any of these chapters — the guideline's Indications field reads simply 'Hip fractures.' It recommends surgery AS SOON AS THE PATIENT IS MEDICALLY STABLE and records faster recovery and lower mortality than non-operative management. Confidence is High. There is no conservative requirement and delay is the thing to argue against, not for.

Reviewing this for COA, or think a criterion is wrong?