CPT 27299 is referenced in 18 tracked payer policy changes from Sentara Health Plans, UnitedHealthcare, and 7 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 27299 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
UnitedHealthcare Medicare Advantage updated its Joint Procedures policy effective October 1, 2026, removing coverage language for acetabuloplasty/Girdlestone procedures, renaming the wrist/thumb surgery section, and modifying applicable CPT codes including additions for FAI syndrome (27299) and removals of codes 25449, 29840, and 27122. Billing teams must update system rules and remove obsolete codes from claims submission workflows.
UnitedHealthcare Medicare Advantage removed coverage for acetabuloplasty/Girdlestone procedures and modified surgical code coverage for hip, wrist, and thumb procedures effective September 1, 2026. Billing teams must remove CPT codes 25449, 29840, and 27122 from claims and add CPT 27299 for Femoroacetabular Impingement syndrome. Updated CMS reference documents are now available.
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.
Blue Cross Blue Shield of North Dakota updated multiple medical policies with new covered services, revised criteria, coding changes, and consent policies effective February 19, 2026. Key changes include new procedure codes for prostate treatments, bone density studies, and various other specialties, plus removal of experimental procedure codes.
Humana Medicare Advantage has revised their hip arthroscopy coverage policy, establishing specific medical necessity criteria including required conservative treatment failure periods (3 months for general hip arthroscopy, 12 months for greater trochanteric pain syndrome) and specific clinical indications. The policy excludes coverage for advanced hip arthritis (Tonnis grade 3) and in-office needle arthroscopy procedures.
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.
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.
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.
Humana Medicare Advantage revised its Hip Arthroplasty coverage policy effective 11/02/2026, updating medical necessity criteria for partial hip arthroplasty (hemiarthroplasty) and hip resurfacing arthroplasty across all jurisdictions. The policy specifies FDA-approved device requirements, patient age thresholds, preoperative A1C limits, and conservative treatment failure documentation for coverage determination.
Open or arthroscopic surgery for femoroacetabular impingement (FAI) may be medically necessary in skeletally mature patients who meet all of the policy criteria. Those criteria include moderate-to-severe hip pain worsened by flexion activities, conservative therapy that has not worked for at least 3 months (or is documented as contraindicated), a positive impingement sign, cam-type or pincer-type morphology on imaging, and none of the listed contraindications, including Tonnis grade II or III osteoarthritis. FAI surgery is considered not medically necessary when these criteria are not met, and capsular plication, labral reconstruction and similar procedures performed during FAI surgery are considered components of and incidental to the FAI procedure.
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.
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.
Surgical treatment of groin pain in athletes is considered investigational under this policy. Groin pain in athletes is also known as athletic pubalgia, sports hernia, or core muscle injury. Surgery is typically reserved for patients who have failed at least 3 months of conservative treatment.
Open or arthroscopic treatment of femoroacetabular impingement may be medically necessary in skeletally mature individuals with documented closure of growth plates who have moderate-to-severe hip pain worsened by flexion activities that significantly limits activities, have been unresponsive to at least 3 months of conservative therapy, and have a positive impingement sign on clinical exam. Imaging must show cam or pincer morphology with a high probability of a causal association with damage, no advanced osteoarthritis (Tonnis grade II or III, or joint space under 2 mm), and no severe Outerbridge grade IV chondral damage; treatment in all other situations is investigational. The 09/14/2026 update changed the description and guidelines with minor changes, left the policy statements unchanged, and removed ICD-9 procedure and diagnosis codes from the code reference.
Metal-on-metal total hip resurfacing with an FDA approved device system may be considered medically necessary as an alternative to total hip replacement when the individual is a candidate for total hip replacement, is likely to outlive a traditional prosthesis, and has no contraindication for total hip resurfacing. Partial hip resurfacing with an FDA-approved device may be considered medically necessary in individuals with osteonecrosis of the femoral head who have one or more contraindications for metal-on-metal implants and meet the listed criteria, and all other types and applications of hip resurfacing are considered investigational. A 09/18/2026 review left the policy statements unchanged and removed ICD-9 procedure and diagnosis codes from the code reference.
This is a reissue of the Independence Administrators FAI surgical treatment policy with no substantive clinical changes. The policy clarifies that it applies ONLY to Independence Administrators claims (not Commercial Independence members) and excludes groups enrolled in the UM vendor program. Billing teams must verify member eligibility and plan type before billing FAI procedures, as Commercial Independence members now use AIM Specialty Health guidelines instead.
This is a routine reissue of Independence Administrators' FAI surgical treatment policy with no material changes to coverage criteria, medical necessity requirements, or billing codes. The policy continues to cover arthroscopic and open FAI procedures (CPT 29914, 29915, 29916, 27299) for appropriate candidates meeting specific clinical criteria, and applies only to Independence Administrators claims (not Commercial Independence members, who use AIM guidelines).
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