P2P Call Guide

How to Win a P2P Call for Total Hip Replacement Denied by MA Plans

Payer-specific strategy, medical necessity arguments, and the exact phrases to use when Medicare Advantage denies Total Hip Replacement (CPT 27130).

Why MA Plans Denies Total Hip Replacement

Conservative management not exhausted

BMI exceeds payer threshold (often >40)

Imaging does not show severe joint disease

Know Medicare Advantage's Criteria

Medicare Advantage plans must cover all services covered by Original Medicare (CMS NCDs and LCDs) but may require prior auth. Plans use various criteria including InterQual, MCG, and proprietary guidelines.

Key policies to know:

  • Must cover all services covered by Original Medicare
  • Can require prior authorization not required by Original Medicare
  • CMS NCDs and LCDs serve as coverage floor
  • Organization determinations must be issued within 14 days (72 hours for expedited)

Building Your Medical Necessity Argument

Document Kellgren-Lawrence grade on imaging

Show failure of NSAIDs, PT, injections, activity modification

Note functional limitations using validated outcome measures

Address BMI and optimization if applicable

P2P Call Tips for MA Plans

Cite the relevant CMS NCD or LCD -- MA plans cannot deny what Medicare covers

If the service has a CMS NCD, that trumps the MA plan's internal criteria

Reference CMS regulations on MA coverage obligations

Request expedited determination if clinical urgency exists

Guidelines to Reference

  • AAOS Clinical Practice Guidelines for Hip OA
  • MCG Criteria for Total Joint Replacement

Relevant CPT Codes

CPT 27130

Specialty: Orthopedics

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