27488
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
17.16
Facility
$1099.89
Non-Facility
$1099.89
Documentation Required
- No specific documentation requirements are provided in this document chunk; follow documentation requirements specified in the applicable MAC LCDs/LRAs and CMS guidance.
- No documentation requirements are specified in the provided text (e.g., required medical records, imaging, or clinical notes are not included in this excerpt).
- No documentation requirements are specified in the provided excerpt.
- Documentation of patient symptoms (e.g., pain or other symptoms) attributable to the prosthesis and justifying revision/replacement (inferred from 'performed when pain or other symptoms are present').
Key Coverage Criteria
- Total joint arthroplasty — inferred from policy title (Total Joint Arthroplasty).
- Total knee arthroplasty — inferred as a likely covered procedure given the source document name (HUMANA-KNEE-ARTHROPLASTY), though no explicit indication text is present in the provided excerpt.
- Total Knee Arthroplasty (as referenced by LCD titles in the document)
- Lower Extremity Major Joint Replacement (Hip and Knee) (as referenced by LCD title L36007)
- 27437: Arthroplasty, patella; without prosthesis
- Total knee arthroplasty (referenced CMS LCD L36577).
2 Active Policies
CARELON-joint-surgery-2024-11-17-updated-2025-01-01 — Joint Surgery
HUMANA-KNEE-ARTHROPLASTY-MA — Knee Arthroplasty - Medicare Advantage
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.