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PAYER POLICY CHANGES

27165 Insurance Policy Changes

CPT 27165, in plain terms, covers Realignment osteotomy of the femur done at or just below the trochanters, with any internal or external fixation plus cast application included in this one code. CPT 27165 is referenced in 3 tracked payer policy changes from Excellus BlueCross BlueShield. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 27165 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 27165 on AAPC

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

  • Community Health Plan of Imperial Valley · Effective December 31, 2025

    Prior authorization required

    Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

  • Fidelis Care · Effective December 31, 2025

    Prior authorization required

    Fidelis Care CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 27165?

CalViva Health lists 27165 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 Community Health Plan of Imperial Valley require prior authorization for 27165?

Community Health Plan of Imperial Valley lists 27165 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.

Does Fidelis Care require prior authorization for 27165?

Fidelis Care lists 27165 on Fidelis Care 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 27165?

There are 3 tracked policy changes affecting CPT 27165, including updates from Excellus BlueCross BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 27165?

Payers that have issued tracked updates for CPT 27165 include: Excellus BlueCross BlueShield.

How do I get notified when CPT 27165 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 27165. 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 27165?

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.

See every payer rule for 27165

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 27165 in one place.

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