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27134

PAYER POLICY CHANGES

27134 Insurance Policy Changes

CPT 27134, in plain terms, covers Revision of a previous total hip replacement involving both the acetabular and femoral components. CPT 27134 is referenced in 13 tracked payer policy changes from Excellus BlueCross BlueShield, Humana, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 27134 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 27134 on AAPC

Excellus BlueCross BlueShield · Effective Jan 1, 2027Medium impact
Orthopedic Joint Procedures of the Hip for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.121
Excellus BlueCross BlueShield medical policy 7.01.121 covers hip joint procedures for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) members, with a current effective date of January 1, 2027. The policy sets medical necessity criteria for partial and total hip arthroplasty, revision hip arthroplasty, hip resurfacing, pediatric osteotomy, hip arthroscopy, and hip labral repair, and it lists indications that are not medically necessary. The policy history lists a 09/17/26 new policy and a 10/22/26 off-cycle review that removed site of care criteria and clarified developmental hip dysplasia and primary cause of surgery.
Excellus BlueCross BlueShield · Effective Jan 1, 2027Medium impact
Orthopedic Joint Procedures of the Hip for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.121
Excellus BlueCross BlueShield medical policy 7.01.121 sets the medical necessity criteria for hip joint procedures for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) members. The current effective date is January 1, 2027. The policy covers partial and total hip arthroplasty, hip resurfacing, pediatric pelvic or femoral osteotomy for developmental dysplasia of the hip, hip arthroscopy, and hip labral repair, and it lists indications that are not medically necessary. The policy history shows a 10/22/26 off-cycle review that removed site of care criteria, clarified developmental hip dysplasia and primary cause of surgery, removed imaging requirements for pediatric osteotomy patients, and reformatted age-appropriate clinical findings.
Humana · Effective Mar 16, 2026High impact
Hip Arthroplasty - Medicare Advantage (Revised)
This is a revised Medicare Advantage policy for hip arthroplasty procedures that establishes detailed coverage criteria for total hip replacement, partial hip replacement (hemiarthroplasty), and hip resurfacing procedures. The policy provides specific medical necessity requirements and contraindications for each type of hip surgery.
Excellus BlueCross BlueShield · Effective Feb 16, 2026High impact
Hip Arthroplasty 7.01.96
Excellus BlueCross BlueShield updated its Hip Arthroplasty policy (7.01.96) effective February 16, 2026, establishing new medical necessity criteria for partial hip replacement, total hip replacement, and revision procedures. The policy introduces specific imaging requirements (Tönnis Grade 2-3 for osteoarthritis), mandates 3 months of function-limiting pain documentation and failed conservative management, includes exception clauses when non-surgical management is inappropriate, and excludes patients on dialysis from total hip replacement coverage. Billing teams must immediately verify patient eligibility against these criteria before claim submission to avoid denials.
Premera Blue Cross · Effective Jan 2, 2026High impact
Medical Policy and Coding Updates - October 2025
Premera HMO plans in Washington have changes from the October 2025 medical policy and coding update. Dated items include the Abdominal Wall Hernia policy and its codes effective January 2, 2026, advanced imaging site-of-care review through Carelon and a Washington mandate for medical clearance of minors' hearing aid coverage effective January 1, 2026, and Federal Employee Program prior authorization for hip, knee and spine surgery effective January 1, 2026. Several biologic and drug policies also moved products between preferred and non-preferred status.
Premera Blue Cross · Identified Jun 16, 2026High impact
Medical Policy and Coding Updates - December 2025
With effective dates from December 1, 2025 through March 4, 2026. The update adds medical necessity and prior authorization review for electrophysiology studies, endovascular stent grafts for abdominal aortic aneurysms, shoulder arthrotomy, gastroesophageal reflux surgery, negative pressure wound therapy devices, and hip, knee and spine surgeries for Standard and Basic Federal Employee Program plans effective January 1, 2026. Several codes were made non-covered or investigational, including the services listed under policy 10.01.517 and transcatheter tricuspid valve procedures.
Premera Blue Cross · Identified Jun 16, 2026High impact
Medical Policy and Coding Updates - January 2026
With effective dates from January 1, 2026 through April 8, 2026. The update adds medical necessity and prior authorization review for electrophysiology studies, endovascular stent grafts for abdominal aortic aneurysms, shoulder arthrotomy, shoulder arthroscopy, abdominal wall hernia repair, and hip, knee and spine surgeries for Standard and Basic Federal Employee Program plans, and it expands site of service ASC review to upper GI endoscopy and shoulder procedures. It also changes many drug criteria, including preferred product and quantity limit updates, adds Carelon review for advanced imaging, and lists codes that became non-covered, investigational or terminated.
Excellus BlueCross BlueShield · Effective Oct 15, 2026Medium impact
Hip Arthroplasty - (Effective Date - 2026-10-15) 7.01.96
Excellus's hip arthroplasty policy, effective October 15, 2026, covers partial and total hip replacement for femoral head or neck fracture, avascular necrosis, osteoarthritis, and inflammatory arthritis when the listed criteria are met. Revision of hip replacement is medically necessary for listed post-operative conditions such as recurrent dislocation, aseptic loosening, periprosthetic joint infection, and periprosthetic fracture. The 06/18/26 annual review left the policy intent unchanged, and a 10/16/25 change removed the renal transplant list from the total hip not medically necessary indications.
Aetna · Identified Oct 3, 2026Medium impact
Hip Arthroplasty (CPB 0287, reviewed 2026-09-23)
Aetna Clinical Policy Bulletin 0287 sets medical necessity criteria for total hip arthroplasty (THA) and for revision or replacement of a THA or hip resurfacing. A primary THA is considered medically necessary for adult members with advanced hip joint disease from osteoarthritis, rheumatoid arthritis, avascular necrosis or post-traumatic arthritis that causes pain and functional disability interfering with activities of daily living, with limited range of motion, antalgic gait and pain on passive range of motion, plus imaging showing stage II or III avascular necrosis or moderate or severe osteoarthritis or rheumatoid arthritis (Tonnis grade 2 or 3), after unsuccessful conservative therapy of 12 or 24 weeks depending on age and BMI, with at least half of it formal in-person physical therapy in the past year. Revision or replacement is considered medically necessary when accompanied by pain and functional disability and imaging confirms aseptic loosening, component fracture or mechanical failure, periprosthetic infection, displaced periprosthetic fracture, progressive periprosthetic bone loss, bearing surface wear with symptomatic synovitis, or recurrent dislocation, and the policy lists computer-assisted surgical navigation, portable accelerometer-based navigation, synovial C-reactive protein and alpha-defensin testing, and obturator nerve blocks among experimental, investigational or unproven services.
Aetna · Identified Aug 16, 2026Medium impact
Hip Arthroplasty (CPB 0287, reviewed 2026-07-17)
Total hip arthroplasty is considered medically necessary for adult members when an FDA-approved implant is used and the member has advanced joint disease, meaning pain and functional disability that interferes with activities of daily living from osteoarthritis, rheumatoid arthritis, avascular necrosis or post-traumatic arthritis, along with limited range of motion, antalgic gait and radiographic evidence of avascular necrosis stage II or III or moderate/severe osteoarthritis or rheumatoid arthritis of the hip. Unsuccessful conservative therapy of 12 or 24 weeks, depending on age and BMI, must be clearly addressed in the medical record, with at least half consisting of formal in-person physical therapy in the past year. Revision or replacement of a total hip arthroplasty or hip resurfacing is covered when imaging confirms an indication such as aseptic loosening, component fracture or mechanical failure, periprosthetic infection, displaced periprosthetic fracture, progressive bone loss, bearing surface wear, recurrent dislocation or clinically significant leg length discrepancy. Computer-assisted navigation, custom joint implants, synovial CRP and alpha-defensin testing, obturator nerve blocks and portable accelerometer-based navigation are listed as experimental, investigational or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Total Hip Arthroplasty (THA)
Total hip arthroplasty is considered medically necessary when all of the listed criteria are met, including a diagnosis of osteoarthritis, osteonecrosis, rheumatoid arthritis, bone tumor involving the hip or acute femoral neck fracture, radiographic hip joint damage, significant persistent pain and functional limitations, and failure of optimal medical management such as weight loss, NSAIDs, DMARDs, cortisone injections, physical therapy, walking aids and reduced physical activity. Revision THA of a failed hip prosthesis may be considered medically necessary when pain or swelling increases significantly or function decreases, in the presence of infection, wear and loosening, malalignment or malposition, fractures or instability. Ambulatory THA and revision THA in adults 18 and older also require ASA Physical Status 3 or less, a BMI of 50 or less, proactive treatment for possible MSSA or MRSA before surgery, the absence of the listed contraindications, and care coordination, and benefits are only provided when the procedure is performed by a Blue Specialty Network Provider in a setting coordinated and contracted with the Company.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Total Hip Arthroplasty (THA) - West Central and North East Region
Total hip arthroplasty (THA) is considered medically necessary when all criteria are met, including a diagnosis of osteoarthritis, osteonecrosis, rheumatoid arthritis, bone tumor involving the hip, or acute femoral neck fracture, radiographic evidence of hip joint damage, significant persistent pain and functional limitations, and optimal medical management tried and failed. The Company requires care coordination for all hip arthroplasty Specialty Services, and hospital hip arthroplasty is covered only when hospital criteria are met and care is coordinated by the Company. This policy applies to Network Providers in the West Central and North East Regions of Mississippi only.
Premera Blue Cross · Identified Jun 18, 2026Medium impact
Medical Policy and Coding Updates - January 2020
This WA and Alaska medical policy and coding update lists changes with effective dates from November 30, 2019 through April 3, 2020. Coding updates list codes such as J2350, 55874, J3060, J9213 and hip arthroplasty codes 27130, 27132, 27134, 27137 and 27138 as now requiring review for medical necessity and prior authorization, and list cosmetic codes 15771 through 15774 as now requiring review and considered cosmetic. Special notices state that Trazimera (trastuzumab-qyyp) is a first-line biosimilar for HER2-positive breast cancer, and that Ruxience (rituximab-pvvr) is a first-line biosimilar for non-Hodgkin's lymphoma and chronic lymphocytic leukemia.

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REFERENCE DATA

Payers with rules20

Payers requiring prior auth20

Aetna · Effective November 1, 2026
Prior authorization required
Participating provider precertification list for Aetna
Anthem BCBS · Effective November 1, 2026
Prior authorization required
Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)
BCBS Michigan · Effective October 13, 2026
Prior authorization required in some cases
BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

FREQUENTLY ASKED QUESTIONS

Does Aetna require prior authorization for 27134?

Aetna lists 27134 on Participating provider precertification list for Aetna for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Ambetter require prior authorization for 27134?

Ambetter lists 27134 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 27134?

Anthem BCBS lists 27134 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 27134?

Arizona Complete Health lists 27134 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for 27134?

BCBS Arizona lists 27134 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 27134?

There are 13 tracked policy changes affecting CPT 27134, including updates from Excellus BlueCross BlueShield, Humana, Premera Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 27134?

Payers that have issued tracked updates for CPT 27134 include: Excellus BlueCross BlueShield, Humana, Premera Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 27134 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 27134. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 27134?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Orthopedic Joint Procedures of the Hip for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.121

Orthopedic Joint Procedures of the Hip for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.121

Hip Arthroplasty - Medicare Advantage (Revised)

Hip Arthroplasty 7.01.96

Medical Policy and Coding Updates - October 2025

Medical Policy and Coding Updates - December 2025

Medical Policy and Coding Updates - January 2026

Hip Arthroplasty - (Effective Date - 2026-10-15) 7.01.96

Hip Arthroplasty (CPB 0287, reviewed 2026-09-23)

Hip Arthroplasty (CPB 0287, reviewed 2026-07-17)

Total Hip Arthroplasty (THA)

Total Hip Arthroplasty (THA) - West Central and North East Region

Medical Policy and Coding Updates - January 2020

Prior authorization required