CPT 27278 ·
27278
27278 (27278) — payor coverage and prior-authorization requirements across all Medicare MACs, commercial payors, BCBS plans, and Medicaid programs tracked by Rubrica.
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Rubrica tracks payor coverage for CPT 27278 (27278) across 1 payors — every Medicare MAC, the major commercial plans, the BCBS family, all 50-state Medicaid programs, and selected workers' comp and auto/PIP carriers. Aggregate coverage patterns are shown below; full payor-specific criteria, source citations, and last-reviewed dates are available to signed-in practitioners.
Top payors covering CPT 27278
Sample of 12 payors with coverage for this code. Sign in for the complete payor list, verbatim criteria, denial-risk score, and source citations for each.
| Payor | Coverage | Prior auth |
|---|---|---|
| BCBS Federal Employee Program | Covered | Prior auth |
Coverage themes for CPT 27278
Common patterns across the 1 payors we track. Specific criteria per payor are available after sign-in.
Most payors require ≥26 weeks of conservative care before approving 27278.
1 of 1 payors require imaging concordance documentation.
Of the 1 payors with coverage records for CPT 27278, 1 require prior authorization, 0 cover without prior authorization, and 0 flag the procedure as investigational or experimental under current criteria.
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