27437 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 27437

30 of 30 payer prior-auth lists that name 27437 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, CarePlus Health Plans, Humana, Neighborhood Health Partnership, Oxford Health Plans, Surest, UnitedHealthcare, UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)Federal Employee Program (FEP)AZprior auth requiredSep 1, 2026Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)
AetnaCommercialAllprior auth requiredNot required for Student Health or Allina Health | Aetna plansOct 1, 2026Participating provider precertification list for Aetna®
AetnaMedicare AdvantageAllprior auth requiredNot required for Student Health or Allina Health | Aetna plansOct 1, 2026Participating provider precertification list for Aetna®
Blue Cross and Blue Shield of IllinoisBlue Cross Community Health Plans (BCCHP), Illinois MedicaidILprior auth requiredCarelon-managedAug 1, 2025Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026
Blue Cross and Blue Shield of TexasTexas PA exemption (gold card), outpatient, fully insuredTXprior auth requiredGold-card exemption availableJul 1, 2026BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
CarePlus Health PlansCarePlus Health PlansFLprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaHumana D-SNP (FL)FLprior auth requiredJan 1, 20271 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
HumanaHumana D-SNP (IL)ILprior auth requiredJan 1, 2027Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
HumanaHumana D-SNP (IN)INprior auth requiredJan 1, 2027*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
HumanaHumana D-SNP (MI)MIprior auth requiredJan 1, 20271 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
HumanaHumana D-SNP (SC)SCprior auth requiredJan 1, 2027Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
HumanaHumana D-SNP (VA)VAprior auth requiredJan 1, 2027Virginia Prior Authorization and Notification List
HumanaHumana Healthy HorizonsILprior auth requiredJan 1, 2027Humana Healthy Horizons in Illinois Prior Authorization and Notification List To view -specific medical coverage policies, please visit Humana Healthy Horizons in Illinois Clinical coverage policies .
HumanaHumana Healthy HorizonsKYprior auth requiredJan 1, 2027please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.
HumanaHumana Healthy HorizonsOHprior auth requiredJan 1, 2027555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list
HumanaHumana MA and D-SNPAllprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaHumana Puerto Rico MA and Dual Medicare-MedicaidPRprior auth requiredNov 3, 2025Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification
HumanaMusculoskeletalAllprior auth requiredHumana Prior Authorization List (PAL): Musculoskeletal Services
HumanaMusculoskeletalAllprior auth requiredHumana Prior Authorization List (PAL): Musculoskeletal Services
HumanaMusculoskeletalAllprior auth requiredHumana Prior Authorization List (PAL): Musculoskeletal Services
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Neighborhood Health PartnershipNeighborhood Health PartnershipFLprior auth requiredSep 1, 2026Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Oxford Health PlansOxford Health PlansAllprior auth requiredOct 1, 2026Prior Authorization Requirements for Oxford Effective October 1, 2026
SurestSurest health plansAllprior auth requiredOct 1, 2026Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcareUnitedHealthcare CommercialAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth requiredSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Individual Exchange plansAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare Mid-Atlantic Health PlansAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare of the River ValleyAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of KentuckyKYprior auth requiredJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026

Payer coverage policies that name 27437

27437 appears in 21 coverage policies from Aetna, Regence, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaBone and Tendon Graft Substitutes and Adjuncts (0411)listed, no stance (range 27301-27499)Aug 18, 2026payer document
AetnaIntraoperative Neurophysiological Monitoring (0697)not covered (range 27301-27599)Jun 19, 2026payer document
AetnaKnee Arthroplasty (0660)covered if criteria are metOct 8, 2026payer document
AetnaKnee Arthroscopy / Osteoarthritis of the Knee (0673)listed, no stanceFeb 19, 2026payer document
AetnaMagnetic Resonance Imaging (MRI) of the Extremities (0171)listed, no stance (range 27437-27447)Mar 31, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 27301-27599)Jul 23, 2026payer document
AetnaRemote Ischemic Conditioning (0814)listed, no stance (range 20000-29999)Nov 20, 2025payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 20100-29999)Jul 29, 2026payer document
RegenceKnee Surgeries (Surgery 229)listed, no stanceJan 1, 2026payer document
UnitedHealthcareSurgery of the Knee (CS068.AD)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (2026T0553JJ)listed, no stanceSep 10, 2026payer document
UnitedHealthcareSurgery of the Knee (for Idaho Only) (CS068ID.D)listed, no stanceAug 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Kansas Only) (CS068KS.05)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Kentucky Only) (CS068KY.13)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Nebraska Only) (CS068NE.AD)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for New Jersey Only) (CS068NJ.Z)listed, no stanceJul 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for New Mexico Only) (CS068NM.F)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for North Carolina Only) (CSNCT0553.08)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Ohio Only) (CS068OH.G)listed, no stanceJul 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Pennsylvania Only) (CS068PA.AA)listed, no stanceJul 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Tennessee Only) (CS068TN.AA)listed, no stanceJul 1, 2026payer document

Recent prior-auth changes

  • Apr 1, 2026: PA removed, UnitedHealthcare Community Plan
  • Nov 1, 2025: PA added, Blue Cross and Blue Shield of Illinois

Medicaid fee-for-service

Prior authorization required or conditional in WA, WV.

  • AZ: $3026.13 (asc), effective Oct 1, 2026
  • CO: $533.90 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $486.03 (physician, non-facility), effective Jan 1, 2026
  • IL: $599.35 (practitioner), effective Jul 1, 2026
  • IN: $512.63 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $450.00 (asc, facility), effective Aug 1, 1982
  • KY: $3607.39 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $2382.86 (asc), effective May 1, 2026
  • MS: $2808.67 (comprehensive, facility), effective Oct 1, 2025
  • ND: $2126.56 (physician, facility), effective Aug 1, 2026
  • NE: $1000.00 (asc), effective Jul 1, 2024
  • OH: $516.12 (physician), effective Jan 1, 2024
  • OK: $3291.10 (asc), effective Jan 1, 2026
  • TX: $2398.52 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $541.38 (medical), effective Jul 1, 2026
  • VT: $5634.17 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $366.60 (asc), effective Jul 1, 2026
  • WY: $3208.96 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.