UnitedHealthcare Prior Authorization for CPT 27130
Total hip arthroplasty in OH
Documents Needed
- Clinical notes
Clinical Criteria
UHC requires prior authorization for total hip arthroplasty (policy SURG-HIP-2026). Criteria: (1) failed conservative treatment including NSAIDs or acetaminophen for at least 3 weeks, or at least 1 intra-articular corticosteroid injection; (2) physical therapy or home exercise program for at least 12 weeks within the last 12 months; (3) activity modification for at least 12 weeks. Diagnostic imaging interpretation required. UHC may request MRI, CT, X-ray, or bone scan.
Source: UnitedHealthcare Commercial Prior Authorization List
Submission Tips
Document medical necessity thoroughly before submitting. Include clinical notes, relevant test results, and a clear rationale for why CPT 27130 is appropriate for the patient's condition.
About CPT 27130
CPT 27130 — Total hip arthroplasty. Prior authorization requirements vary by payer, plan type, and state. UnitedHealthcare requires prior authorization for this procedure in OH.
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The information provided on this page is for educational and informational purposes only. While we strive to maintain the most current and accurate prior authorization data, requirements change frequently and vary by individual plan type. Always verify prior authorization requirements directly with the payer before performing a procedure. D3rx is not responsible for any claim denials or reimbursement issues.