Change to Utilization Review Process for Total Knee Arthroplasty

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Effective April 1, 2019, WSI will no longer require all total knee arthroplasty procedures be performed in the inpatient hospital setting. The Utilization Review (UR) department will now allow for the approval of a total knee arthroplasty described by CPT codes 27446 or 27447 in the outpatient hospital and ambulatory surgical center settings. WSI’s UR department utilizes Official Disability Guidelines (ODG) as the standard of care in the review of services requiring prior authorization. ODG includes guidelines for Knee Joint Replacement and Outpatient Joint Replacement Treatment Guidelines, which outline the clinical indications of medical necessity for this procedure.

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