CPT 27134 · Other Procedure · BCBS Montana
Revision THA — Both Components at BCBS Montana.
How BCBS Montana approaches CPT 27134 (Revision THA — Both Components) for prior-authorization review: at last review on 2026-01-01, the policy covers this code with prior authorization required.
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Coverage
Covered
Prior auth
Prior auth required
Last reviewed
2026-01-01
Policy number
Carelon Joint Surgery 2025-11-15Criteria summary
High-level themes from the BCBS Montana policy of record for CPT 27134. Verbatim policy text and per-criterion analysis are available after sign-in.
- Imaging concordance documentation required.
- Prior diagnostic procedure documentation required.
Source: Carelon Clinical Appropriateness Guidelines — Joint Surgery (Revision)
See the full BCBS Montana criteria.
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