CPT code 27447 covers total knee arthroplasty (total knee replacement). This is one of the most commonly performed surgical procedures in the United States, with over 700,000 procedures annually. It is subject to prior authorization by virtually all insurers.
All major insurers require prior authorization for total knee replacement. PA criteria typically require documented failure of conservative treatment (minimum 3-6 months), weight-bearing X-rays showin... Always verify requirements with the specific insurer and plan.
Total knee replacement is performed for end-stage knee osteoarthritis, rheumatoid arthritis, and post-traumatic arthritis that has failed conservative management. The procedure involves replacing the damaged joint surfaces with prosthetic components.
All major insurers require prior authorization for total knee replacement. PA criteria typically require documented failure of conservative treatment (minimum 3-6 months), weight-bearing X-rays showing significant joint space narrowing, and documentation of functional impairment. Many insurers also require BMI below a certain threshold.
Note: PA requirements vary by specific plan and member. Always verify requirements with the insurer before scheduling.
Include weight-bearing X-rays showing bone-on-bone contact or severe joint space narrowing.
Document at least 3-6 months of conservative treatment including PT, medications, and injections.
Provide functional assessment scores (WOMAC, KOOS) demonstrating significant impairment.
Some insurers require BMI below 40. Document current BMI and any weight management efforts.
Include documentation from all conservative treatment modalities tried.
Greenlight Medical detects when CPT 27447 requires prior auth, assembles all documentation automatically, and submits to the correct payer portal. No manual lookups, no phone calls, no faxes.
See Greenlight in ActionYes, total knee replacement (CPT 27447) requires prior authorization from virtually all insurers. Extensive documentation of failed conservative treatment, imaging findings, and functional impairment is required.
Most insurers require 3-6 months of documented conservative treatment failure, including physical therapy, oral anti-inflammatory medications, and typically at least one corticosteroid injection. Some insurers also require a trial of viscosupplementation (hyaluronic acid injections).
Some insurers have BMI thresholds for total knee replacement approval, commonly requiring BMI below 40. If the patient's BMI is above the threshold, documentation of weight management efforts and medical necessity despite the elevated BMI may be needed.