Medicare AdvantageCoverageHigh impact
Hip Arthroplasty - Medicare Advantage (Revised)
Humana·Orthopedics·Medicare Advantage
Effective date
Mar 16, 2026
We identified it
Jun 24, 2026
Summary
This is a revised Medicare Advantage policy for hip arthroplasty procedures that establishes detailed coverage criteria for total hip replacement, partial hip replacement (hemiarthroplasty), and hip resurfacing procedures. The policy provides specific medical necessity requirements and contraindications for each type of hip surgery.
Action Required
Before March 16, 2026: Billing team must update prior authorization workflows and documentation requirements for hip arthroplasty procedures (CPT 27125, 27130, 27132, 27134, 27137, 27138, 27299). Ensure providers document specific medical necessity criteria outlined in the policy, including age requirements for hemiarthroplasty (65+ years), absence of active infection, and failed conservative treatment history. Update EMR templates to capture required clinical indicators and contraindications. Claims not meeting the established criteria will be denied.