CPT 27134 · Arthroplasty — Hip · Premera Blue Cross
Revision THA — Both Components at Premera Blue Cross.
How Premera Blue Cross approaches CPT 27134 (Revision THA — Both Components) for prior-authorization review: at last review on 2026-05-02, the policy covers this code with prior authorization required.
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Surgery 7.01.529Criteria summary
High-level themes from the Premera Blue Cross 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: Premera Blue Cross Medical Policy — Total Hip Arthroplasty (Revision)
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