27161 Insurance Policy Changes

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.