CPT 27403, in plain terms, covers Open repair of a torn knee meniscus, medial or lateral. CPT 27403 is referenced in 10 tracked payer policy changes from UnitedHealthcare, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 27403 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 27403 on AAPC
UnitedHealthcare is removing a long list of CPT codes from the applicable-code list of its Outpatient Surgical Procedures site-of-service policy for Exchange plans, and it is also removing the link to the Manipulation Under Anesthesia policy. The change takes effect December 1, 2026. The source does not state a new billing requirement for the removed codes.
Effective December 1, 2026, UMR removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, UMR's site-of-service policy no longer applies, so the practice should update its internal UMR site-of-service and prior authorization lists before that date.
Effective December 1, 2026, UnitedHealthcare removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, the site-of-service policy no longer applies under this UnitedHealthcare commercial policy, so the practice should update its internal site-of-service and prior authorization lists before that date.
Excellus BlueCross BlueShield medical policy 7.01.123 covers knee 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 knee arthroplasty, knee arthroscopy and associated procedures, ligament reconstruction and repair, meniscal procedures, patellofemoral realignment, restorative cartilage procedures, and manipulation under anesthesia, including physical therapy, pain management, imaging, and BMI requirements. The policy history lists a 09/17/26 new policy and a 10/22/26 off-cycle update that removed site of service criteria.
Excellus BlueCross BlueShield medical policy 7.01.123 sets the medical necessity criteria for knee 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 total, revision and partial knee arthroplasty, patellofemoral arthroplasty, diagnostic and surgical knee arthroscopy, chondroplasty, debridement, ligament reconstruction and repair, meniscal procedures, patellar realignment, lysis of adhesions, manipulation under anesthesia, and restorative cartilage procedures, each with its own criteria. The policy history shows a 10/22/26 off-cycle update that removed site of service criteria.
Blue Cross and Blue Shield of Nebraska's updates effective 11/01/2026, which have already taken effect, add a new Evolent preauthorization requirement for listed hip, knee and shoulder surgery codes, a preauthorization requirement for psychological and neuropsychological testing after the fifth hour of testing, and new codes 15271 through 15278 under its amniotic membrane and bioengineered skin substitute policies. All of these require preauthorization according to the notice.
Blue Cross and Blue Shield of Nebraska's MPC November 2026 update lists two policies effective 11/01/2026. New policy III.277 Evolent Joint Surgery (Hip, Knee, Shoulder Surgeries) applies to all employer groups and requires preauthorization, which Evolent performs. Revised policy I.200 Amniotic Membrane and Amniotic Fluid and I.202 Bioengineered Skin and Soft Tissue Substitutes adds codes 15271 through 15278 and also requires preauthorization.
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.
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