Anthem/Elevance Health Shoulder Arthroscopy Rotator Cuff Repair prior authorization requirements (2026)

What Anthem/Elevance Health generally requires to approve Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827), for Commercial plans. Yes. Anthem/Elevance Health generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).

General reference compiled from public sources. This is not a coverage determination or medical advice. Always confirm current requirements with Anthem/Elevance Health before submitting.

Medical-necessity criteria Anthem/Elevance Health generally applies

(1) MRI confirming rotator cuff tear (full-thickness or partial ≥50%); (2) Symptoms ≥6 weeks; (3) Formal PT failure ≥6 weeks with rotator cuff-specific protocol; (4) Documented functional deficit (ROM limitation, weakness, ADL impairment); (5) AIM/Carelon pathway if plan-routed

Diagnoses that commonly support medical necessity

ICD-10-CM diagnoses frequently associated with medical necessity for Shoulder Arthroscopy Rotator Cuff Repair. Confirm the covered diagnosis list against the current Anthem/Elevance Health policy.

M75.100Unspecified rotator cuff tear or rupture, not specified as traumatic, unspecified shoulderM75.101Unspecified rotator cuff tear or rupture, not specified as traumatic, right shoulderM75.102Unspecified rotator cuff tear or rupture, not specified as traumatic, left shoulder

Commonly required documentation

  • MRI with tear characterization
  • PT records
  • shoulder functional scores
  • ROM and strength
  • AIM authorization if applicable

How to submit

Source

Check if member plan uses Carelon for MSK. Cohere Health or other specialty UM may apply for some Anthem products.

Frequently asked questions

Does Anthem/Elevance Health require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair?

Yes. Anthem/Elevance Health generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).

What does Anthem/Elevance Health require to approve Shoulder Arthroscopy Rotator Cuff Repair?

(1) MRI confirming rotator cuff tear (full-thickness or partial ≥50%); (2) Symptoms ≥6 weeks; (3) Formal PT failure ≥6 weeks with rotator cuff-specific protocol; (4) Documented functional deficit (ROM limitation, weakness, ADL impairment); (5) AIM/Carelon pathway if plan-routed Always confirm against the current Anthem/Elevance Health policy.

How long does a Anthem/Elevance Health prior authorization take?

Anthem/Elevance Health typically decides Shoulder Arthroscopy Rotator Cuff Repair requests in about 3 days. Timeframes vary; check the payer portal.

Submitting Shoulder Arthroscopy Rotator Cuff Repair to Anthem/Elevance Health?

Praxigen checks your clinical note against these criteria before you submit and drafts a policy-cited appeal if it is denied. You review and submit; nothing is sent automatically.

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Other Anthem/Elevance Health prior authorization requirements

Anterior Cervical Discectomy and FusionArthroscopic Hip Surgery for Impingement Syndrome Including Labral RepairCarpal Tunnel SurgeryCT Abdomen and Pelvis with contrastCTA Chest (e.g., pulmonary embolism)Dorsal Column (Lumbar) Neurostimulators: Trial or ImplantationKnee ArthroscopyKnee MeniscectomyLumbar Spinal FusionMRI Brain without contrastMRI Cervical Spine without contrastMRI Lower Extremity Joint without contrast

Related guides

Why was my prior authorization denied? Top reasons and how to fix eachHow to write a prior authorization appeal that cites policy