CommercialPrior AuthHigh impact
Total Hip Arthroplasty (THA) - West Central and North East Region
Blue Cross & Blue Shield of Mississippi·MS · Orthopedics·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi updated their Total Hip Arthroplasty (THA) policy for West Central and North East regions, requiring care coordination for all hip arthroplasty specialty services to determine medical necessity and appropriate place of treatment. The policy establishes specific hospital criteria for THA procedures based on patient risk factors.
Action Required
Immediately: Billing team must ensure care coordination is obtained through BCBS Mississippi for all Total Hip Arthroplasty procedures (CPT 27130, 27132, 27134, 27137) before scheduling surgery. Providers must document patient meets hospital criteria if performing procedure in hospital setting. Update prior authorization workflows to include BCBS MS care coordination requirement. Claims may be denied without proper care coordination.