27137 prior authorization | Premera Blue Cross of Washington
27137, Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft These criteria do not imply or guarantee approval., is on the Premera Blue Cross of Washington prior authorization list. Not a coverage or referral decision.
- Code
- 27137
- Description
- Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft These criteria do not imply or guarantee approval.
- Source
- Clinical Review by Code List PBCWA, Pg 266 Original policy