Does Ambetter require prior authorization for 27445?

Ambetter lists 27445 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for 27445?

AmeriHealth Caritas lists 27445 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 27445?

Arizona Complete Health lists 27445 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for 27445?

BCBS Illinois lists 27445 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 27445?

BCBS Michigan lists 27445 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 27445?

There are 11 tracked policy changes affecting CPT 27445, including updates from Premera Blue Cross, Blue Cross Blue Shield of Wyoming, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

How do I get notified when CPT 27445 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 27445. 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 27445?

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.

PAYER POLICY CHANGES

27445 Insurance Policy Changes

Q: Which payers have updated policy for CPT 27445?

Payers that have issued tracked updates for CPT 27445 include: Premera Blue Cross, Blue Cross Blue Shield of Wyoming, Independence Blue Cross, BCBS Michigan, Arkansas Medicaid.

CPT 27445 is referenced in 11 tracked payer policy changes from Premera Blue Cross, Blue Cross Blue Shield of Wyoming, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 27445 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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.
Blue Cross Blue Shield of Wyoming · Effective Jan 1, 2026High impact
Enhancing Provider Support During Open Enrollment
Starting January 1, 2026, Federal Employee Health Benefits (FEHB) and Postal Service Health Benefits (PSHB) Standard or Basic Option plans will require prior authorization for all hip, knee, and spine surgeries. Blue Cross Blue Shield Wyoming has also expanded their provider service team during open enrollment to handle increased call volumes.
Independence Blue Cross · Effective Jan 1, 2026High impact
00.01.66r, Musculoskeletal Services (Independence)
Independence Blue Cross has updated policy 00.01.66r to version 00.01.66u, which includes CPT code narrative revisions (CPT 27279 revised, CPT 27445 terminated/removed) and references updated Carelon Medical Benefits Management Clinical Appropriateness Guidelines for musculoskeletal services effective 01/01/2026. The policy delegates utilization management and medical necessity determination for spinal, joint, and interventional pain management procedures to Carelon, requiring precertification for designated services.
BCBS Michigan · Effective Jan 1, 2026High impact
Select musculoskeletal procedure codes continue to require prior authorization through e-referral for FEP members, won’t move to TurningPoint
For Blue Cross Blue Shield Federal Employee Program (FEP) members with commercial plans, prior authorization continues to be required through e-referral for select musculoskeletal procedures including hip, knee, and spinal surgeries effective January 1, 2026. These procedures will NOT move to TurningPoint Healthcare Solutions as previously announced.
Arkansas Medicaid · Effective Jan 1, 2026High impact
2026 Annual and Quarter 1 Healthcare Common Procedure Coding System Level II (HCPCS) Code, Current Procedural Terminology (CPT), and ASC Code Conversion
The Arkansas Department of Human Services has completed a review of the 2026 annual HCPCS and CPT procedure codes and will begin accepting the updated codes. New procedure codes are payable for dates of service on or after 1/1/2026, and the terminated codes listed in Section III are non-payable for dates of service after 12/31/2025. Drug procedure codes require National Drug Code (NDC) billing, except radiopharmaceuticals, vaccines and allergen immunotherapy.
Premera Blue Cross · Identified Jun 16, 2026High impact
Medical Policy and Coding Updates - November 2024
Premera's November 2024 medical policy and coding update changes medical necessity criteria for several drugs and services, including Dupixent, Xolair, trastuzumab and rituximab products, and GnRH analogs. It also adds coding updates that require review for medical necessity and prior authorization, including knee arthroplasty codes 27440, 27442, 27443 and 27445, amyloid antibody code J0175, and codes for biofeedback, endometrial ablation, home apnea monitoring and posterior tibial nerve stimulators.
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.
Premera Blue Cross · Identified Jun 16, 2026High impact
Medical Policy and Coding Updates - May 2026
Premera Washington policy changes carry effective dates from May 1, 2026 through September 4, 2026, and all of those dates had passed as of 2026-11-05. Several services now require review for medical necessity and prior authorization, including Prostate Artery Embolization, Hematopoietic Cell Transplantation for Acute Myeloid Leukemia, and Diagnosis and Treatment of Sacroiliac Joint Pain, and several drugs and procedures now also require review for site of service. Other changes add or remove drugs from pharmacy criteria, add quantity limits, extend initial authorization periods, and mark some procedures as investigational.
Independence Blue Cross · Effective Jan 1, 2026Medium impact
MA00.047r, Musculoskeletal Services
Independence Blue Cross updated MA00.047r (Musculoskeletal Services) to MA00.047u effective 01/01/2026 as part of annual CPT code updates. CPT 27279 narrative was revised and CPT 27445 was terminated/removed from coverage. Billing teams must verify their systems reflect the removal of CPT 27445 and any changes to CPT 27279 documentation requirements for spinal and joint surgical procedures under Medicare Advantage plans.
Premera Blue Cross · Identified Jun 18, 2026Medium impact
Medical Policy and Coding Updates - June 2020
Effective June 1, 2020, Otrexup, Rasuvo, Trexall and Xatmep were added to the new Folate Antimetabolites policy, and Braftovi with Erbitux was added for metastatic colorectal cancer with a BRAF V600E mutation in adults. H-wave stimulation and the Cefaly headband were added to investigational services under the Electrical Stimulation Devices policy, and the surgical treatment of snoring and obstructive sleep apnea policy was renumbered to 7.01.101 and replaced policy 7.01.554. Coding updates made CPT 0507T subject to investigative review, required medical necessity and prior authorization review for HCPCS J9145, G2082 and G2083, removed that review for CPT 97129, 97130 and 27445, and required medical necessity review for SARS-CoV-2 serology CPT 86328 and 86769 starting May 27, 2020.

Watch 27445

Get one email when a payer policy names 27445, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

See every payer rule for 27445

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 27445 in one place.

See every payer rule

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

Medical Policy and Coding Updates - October 2025

Enhancing Provider Support During Open Enrollment

00.01.66r, Musculoskeletal Services (Independence)

Select musculoskeletal procedure codes continue to require prior authorization through e-referral for FEP members, won’t move to TurningPoint

2026 Annual and Quarter 1 Healthcare Common Procedure Coding System Level II (HCPCS) Code, Current Procedural Terminology (CPT), and ASC Code Conversion

Medical Policy and Coding Updates - November 2024

Medical Policy and Coding Updates - December 2025

Medical Policy and Coding Updates - January 2026

Medical Policy and Coding Updates - May 2026

MA00.047r, Musculoskeletal Services

Medical Policy and Coding Updates - June 2020

Prior authorization required in some cases