Orthopedic Joint Procedures of the Hip for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.121
Excellus BlueCross BlueShield medical policy 7.01.121 sets the medical necessity criteria for hip 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 partial and total hip arthroplasty, hip resurfacing, pediatric pelvic or femoral osteotomy for developmental dysplasia of the hip, hip arthroscopy, and hip labral repair, and it lists indications that are not medically necessary. The policy history shows a 10/22/26 off-cycle review that removed site of care criteria, clarified developmental hip dysplasia and primary cause of surgery, removed imaging requirements for pediatric osteotomy patients, and reformatted age-appropriate clinical findings.