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PAYER POLICY CHANGES

27425 Insurance Policy Changes

CPT 27425, in plain terms, covers Surgeon releases the lateral retinaculum of the knee through open incision to decompress the kneecap. CPT 27425 is referenced in 8 tracked payer policy changes from Excellus BlueCross BlueShield, Blue Cross Blue Shield of Nebraska, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 27425 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 27425 on AAPC

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REFERENCE DATA

Payers with rules16
Payers requiring prior auth16
  • Anthem BCBS · Effective November 1, 2026

    Prior authorization required

    Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)

  • 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)

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 27425?

Ambetter lists 27425 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 Anthem BCBS require prior authorization for 27425?

Anthem BCBS lists 27425 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for 27425?

BCBS Arizona lists 27425 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 27425?

BCBS Illinois lists 27425 on 2026 Commercial Outpatient Medical Surgical Prior Authorization Codes for commercial plans, with conditions (list dated January 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for 27425?

BCBS Michigan lists 27425 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.

What insurance policy changes affect CPT 27425?

There are 8 tracked policy changes affecting CPT 27425, including updates from Excellus BlueCross BlueShield, Blue Cross Blue Shield of Nebraska, Capital Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 27425?

Payers that have issued tracked updates for CPT 27425 include: Excellus BlueCross BlueShield, Blue Cross Blue Shield of Nebraska, Capital Blue Cross, Premera Blue Cross.

How do I get notified when CPT 27425 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 27425. 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 27425?

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 27425

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 27425 in one place.

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