Prior Authorization
Humana Prior Authorization for CPT 27442
Arthroplasty procedures · Standard commercial plans
Source
Data pending source-document linkage. Verify against Humana's current clinical policy before submission.
Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Orthopedic surgeries - Hip, knee and shoulder arthroplasty
Documentation checklist
- ✓Clinical notes
2026 Medicare rate for CPT 27442
Office (non-facility)
$804.96
Facility
$804.96
Total RVUs (office)
24.10
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Humana's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 27442 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Clinical notes.
- 3Submit via the payer's provider portal or designated PA channel.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Humana require prior authorization for CPT 27442?
- Yes. Humana requires prior authorization for CPT 27442 (Arthroplasty procedures) under Standard commercial plans per its published clinical policy.
- What documentation does Humana require for CPT 27442?
- Clinical notes
- How much does Medicare pay for CPT 27442 in 2026?
- In 2026, the national Medicare allowable for CPT 27442 is $804.96 in an office setting and $804.96 in a facility. Commercial allowables for Humana are typically negotiated against this benchmark.
- What if Humana denies the PA for CPT 27442?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Humana PA lookups
CPT 27442 prior authorization by payer
Draft the Humana PA request for CPT 27442 — free
Ask D3 builds a payer-ready prior-authorization request with the right criteria language and documentation — backed by CMS, Medicare, and major-payer data. No signup.