What this is, in plain language
Surgery that replaces a damaged hip joint with an artificial ball and socket.
Why a clinician orders it
Severe hip arthritis or joint damage causing pain and limiting walking, after conservative treatments have failed.
Medical necessity — what insurers usually look at
Insurers typically require documented conservative treatment first — physical therapy, anti-inflammatory medications, sometimes injections — plus X-rays showing joint damage. Prior authorization is commonly required.
New to this? Read what medical necessity means and how to appeal a denial.
Documentation to ask about
- ✓X-ray or imaging showing joint damage
- ✓Conservative treatments tried and failed
- ✓Prior auth approval in writing
- ✓In-network facility and surgeon
Questions for your provider
- ?What conservative treatments does my plan require first?
- ?Has prior auth been approved in writing?
- ?Will I go home the same day or stay overnight — and how does that affect cost?
Why this code is in our seed set
One of the highest-volume major surgeries in Medicare; in the CMS Top 200 Ranked by Services.
Validated against
- •CMS Top 200 Level I CPT Codes Ranked by Services
- •AAOS Clinical Practice Guideline for Hip Osteoarthritis
- •AMA CPT code 27130 descriptor
Terms you'll see
Some services may need plan approval before they are performed.
Lower-risk care that insurers may want documented before a bigger procedure.
The insurer is reviewing whether the service is clinically appropriate for your situation.