27170 Insurance Policy Changes

CPT 27170, in plain terms, covers A surgical procedure to fix or rebuild the upper thighbone where it connects to the hip joint. CPT 27170 is referenced in 4 tracked payer policy changes from Excellus BlueCross BlueShield and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 27170 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 27170 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.
Aetna · Identified Aug 15, 2026Medium impact
Core Decompression for Avascular Necrosis (CPB 0753, reviewed 2025-10-30)
Aetna considers core decompression medically necessary for early or pre-collapse avascular necrosis of the hip, meaning stage I or II before X-ray changes are evident, and the presence of cysts is considered stage II under the Ficat classification. Core decompression is experimental, investigational or unproven for late or post-collapse hip disease (stage III or higher, when X-ray changes have occurred), for avascular necrosis of other joints such as the ankle, elbow, knee, mandibular condyle and shoulder, and for post-arthroscopic osteonecrosis. Adjunctive treatments for avascular necrosis of any joint, including bone morphogenic proteins, growth factors, mesenchymal stem cells, platelet-rich plasma, synthetic bone graft substitutes and biological augmentation with retro-drilling core decompression, are also listed as experimental, investigational or unproven.

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REFERENCE DATA

Payers with rules2

Payers requiring prior auth2

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

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 27170?

CalViva Health lists 27170 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 27170?

Community Health Plan of Imperial Valley lists 27170 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 27170?

There are 4 tracked policy changes affecting CPT 27170, including updates from Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 27170?

Payers that have issued tracked updates for CPT 27170 include: Excellus BlueCross BlueShield, Aetna.

How do I get notified when CPT 27170 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 27170. 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 27170?

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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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