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UnitedHealthcareMedicaid · Documentation · Prior authorization updates · AZ, CO, FL, HI, KS, LA, MD, MI, MO, NE, NJ, NM, NY, NC, OH, PA, RI, TN, TX, VA, WA, WI · OrthopedicsHigh impact

Medicaid: Required documentation changes for hip and knee total joint replacements

Act
by Dec 1, 2025
Effective date
Dec 1, 2025
Identified
Jan 12, 2026

Summary

UnitedHealthcare Community Plan (Medicaid) now requires enhanced medical documentation for prior authorization of total hip and knee joint replacement surgeries (CPT 27447, 27130, 27132) when performed for osteoarthritis. New requirements include detailed imaging reports with specific findings and provider specialties who interpreted images, rolling out across multiple states with different effective dates.

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What to do

by Dec 1, 2025 · 4 steps
01Billing team must update prior authorization submission processes for CPT codes 27447, 27130, and 27132 to include comprehensive imaging documentation with detailed reports, clinical findings, impressions, and interpreting provider specialties.
02Ensure conservative care documentation (NSAIDs ≥3 weeks, PT ≥12 weeks, activity modification ≥12 weeks) remains complete.
03Update submission checklists for affected states.
04Prior authorizations without complete documentation will be denied.

Codes mentioned

274472713027132

Original notice

Medicaid: Required documentation changes for hip and knee total joint replacements
uhcprovider.com · Always check the source before changing claims.
View original ↗

Related policy hubs

UnitedHealthcare policiesAZ policy changesCO policy changesFL policy changesHI policy changesKS policy changesLA policy changesMD policy changesMI policy changesMO policy changesNE policy changesNJ policy changesNM policy changesNY policy changesNC policy changesOH policy changesPA policy changesRI policy changesTN policy changesTX policy changesVA policy changesWA policy changesWI policy changesOrthopedicsCode 27447Code 27130Code 27132

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