Home
Billing codes
27420

PAYER POLICY CHANGES

27420 Insurance Policy Changes

CPT 27420, in plain terms, covers Surgeon realigns or stabilizes the kneecap (patella) through open surgery to correct instability. CPT 27420 is referenced in 7 tracked payer policy changes from Excellus BlueCross BlueShield, Blue Cross Blue Shield of Nebraska, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 27420 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 27420 on AAPC

Excellus BlueCross BlueShield · Effective Jan 1, 2027Medium impact
Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.123
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 · Effective Jan 1, 2027Medium impact
Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.123
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 Blue Shield of Nebraska · Effective Nov 1, 2026High impact
Medical Policy Updates Effective 11/01/2026
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 Blue Shield of Nebraska · Effective Nov 1, 2026High impact
MPC November 2026
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 Blue Cross · Effective Jan 2, 2026High impact
Medical Policy and Coding Updates - October 2025
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.
Premera Blue Cross · Identified Jun 16, 2026High impact
Medical Policy and Coding Updates - December 2025
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.
Premera Blue Cross · Identified Jun 16, 2026High impact
Medical Policy and Coding Updates - January 2026
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.

Watch 27420

Get one email when a payer policy names 27420, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

REFERENCE DATA

Payers with rules12

Payers requiring prior auth12

BCBS Michigan · Effective October 13, 2026
Prior authorization required in some cases
BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)
BCBS Arizona · Effective October 1, 2026
Prior authorization required
AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Updated 10/01/2026)
BCBS Illinois · Effective October 1, 2026
Prior authorization required in some cases
Blue Cross Community Health Plans (Illinois Medicaid) Prior Authorization Code List

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 27420?

Ambetter lists 27420 on Ambetter Health of Delaware CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for 27420?

BCBS Arizona lists 27420 on AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Updated 10/01/2026) for medicare advantage plans (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for 27420?

BCBS Illinois lists 27420 on Blue Cross Community Health Plans (Illinois Medicaid) Prior Authorization Code List for medicaid managed plans, with conditions (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for 27420?

BCBS Michigan lists 27420 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 27420?

CalViva Health lists 27420 on CalViva Health 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 27420?

There are 7 tracked policy changes affecting CPT 27420, including updates from Excellus BlueCross BlueShield, Blue Cross Blue Shield of Nebraska, Premera Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 27420?

Payers that have issued tracked updates for CPT 27420 include: Excellus BlueCross BlueShield, Blue Cross Blue Shield of Nebraska, Premera Blue Cross.

How do I get notified when CPT 27420 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 27420. 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 27420?

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 27420

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 27420 in one place.

See every payer rule

All billing codes J3590 C9399 J3490 99215 99213 99202

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.123

Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.123

Medical Policy Updates Effective 11/01/2026

MPC November 2026

Medical Policy and Coding Updates - October 2025

Medical Policy and Coding Updates - December 2025

Medical Policy and Coding Updates - January 2026

Prior authorization required in some cases

Prior authorization required