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27146

PAYER POLICY CHANGES

27146 Insurance Policy Changes

CPT 27146, in plain terms, covers The surgeon cuts and repositions a pelvic bone, the ilium, acetabulum, or innominate, commonly for hip dysplasia, with no femoral cut and no reduction of the hip. CPT 27146 is referenced in 8 tracked payer policy changes from Excellus BlueCross BlueShield, Premera Blue Cross, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 27146 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 27146 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.
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.
Aetna · Identified Oct 27, 2026Medium impact
Hip Preservation Surgery (CPB 0736, reviewed 2026-10-26)
Aetna Clinical Policy Bulletin 0736, reviewed 2026-10-26, covers hip preservation surgery, including femoro-acetabular surgery, hip arthroscopy and pelvic osteotomy. Aetna considers femoro-acetabular surgery for hip impingement syndrome medically necessary when the policy criteria are met, including definite femoro-acetabular impingement (FAI) shown by imaging with labral pathology and a cam, pincer or pistol grip finding, moderate to severe FAI symptoms for at least 6 months, and failure to respond to all available conservative treatment. Hip arthroscopy to repair a labral tear is considered medically necessary for traumatic labral tears causing mechanical symptoms or as an adjunct to FAI surgery, and repair of complete gluteus medius tears is considered medically necessary. Hip arthroscopy for removal of loose bodies, removal of foreign bodies, and synovectomy in limited instances of inflammatory arthritis is covered when no significant osteoarthritis is present (Tonnis 0 or 1). Endoscopic tenotomy for iliopsoas tendinopathy following total hip arthroplasty is covered after the failure of at least 6 weeks of formal in-person physical therapy in the past year and at least one therapeutic injection with significant but temporary benefit in the past 6 months. Pelvic osteotomy for acetabular dysplasia (not borderline) is medically necessary for members with an LCEA of less than 20 degrees and/or a Tonnis angle over 12 degrees, no or at most mild osteoarthritis (Tonnis 0 or 1), at least 6 months of symptoms, and age under 45. Aetna considers arthroscopic hip surgery experimental, investigational or unproven for all other indications. The policy also lists procedures that are experimental, investigational or unproven when provided as an adjunct to FAI surgery, and lists CPT codes that are not covered for the indications it lists.
Aetna · Identified Aug 16, 2026Medium impact
Hip Preservation Surgery (CPB 0736, reviewed 2026-07-31)
Aetna considers hip preservation surgery medically necessary when the criteria in its policy are met, including femoro-acetabular surgery for hip impingement syndrome, hip arthroscopy to repair traumatic labral tears causing mechanical symptoms, repair of complete gluteus medius tears, and pelvic osteotomy for acetabular dysplasia (not borderline dysplasia). For hip impingement, the criteria require definite femoro-acetabular impingement on imaging with labral pathology, at least 6 months of moderate to severe symptoms, a positive impingement sign, and failure to respond to all available conservative treatment for at least 12 weeks in the past year, with at least 6 weeks of formal in-person physical therapy. Aetna considers arthroscopic hip surgery experimental, investigational, or unproven for all other indications.

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REFERENCE DATA

Payers with rules6

Payers requiring prior auth6

Aetna · Effective November 1, 2026
Prior authorization required
Participating provider precertification list for Aetna
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)
CalViva Health · Effective December 31, 2025
Prior authorization required
CalViva Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Aetna require prior authorization for 27146?

Aetna lists 27146 on Participating provider precertification list for Aetna for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for 27146?

BCBS Michigan lists 27146 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 27146?

CalViva Health lists 27146 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Capital Blue Cross require prior authorization for 27146?

Capital Blue Cross lists 27146 on Capital Blue Cross single source preauthorization code list for commercial plans, with conditions. Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 27146?

Community Health Plan of Imperial Valley lists 27146 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 27146?

There are 8 tracked policy changes affecting CPT 27146, including updates from Excellus BlueCross BlueShield, Premera Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 27146?

Payers that have issued tracked updates for CPT 27146 include: Excellus BlueCross BlueShield, Premera Blue Cross, Aetna.

How do I get notified when CPT 27146 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 27146. 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 27146?

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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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 27146 in one place.

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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 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 Preservation Surgery (CPB 0736, reviewed 2026-10-26)

Hip Preservation Surgery (CPB 0736, reviewed 2026-07-31)

Prior authorization required

Prior authorization required in some cases