Braven Health Shoulder Arthroscopy Rotator Cuff Repair prior authorization requirements (2026)
What Braven Health generally requires to approve Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827), for medicare_advantage plans. Yes. Braven Health generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
Medical-necessity criteria Braven Health generally applies
Prior authorization required (rotator cuff repair is an orthopedic service under TurningPoint). Documented standard: conservative therapy first; PT notes plus imaging required. CONFIRM that CPT 29827 appears on TurningPoint's orthopedic code list (the public list did not render at sourcing); treat as PA-required and verify. Exact thresholds in TurningPoint policy library.
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 Braven Health policy.
How to submit
- Method: TurningPoint (Availity / portal / 1-833-436-4083)
- Portal: TurningPoint Healthcare Solutions
Sources & verification
- BindingSource — Surgical & Implantable Device Management Program — Orthopedic Services.View
Binding = the payer's own policy. Proxy = a public, evidence-based clinical guideline the payer mirrors. Portal-only = the binding criteria are confirmed in the administrator's portal. Always confirm against the payer for the member's specific plan. Last verified 2026-06-26.
Frequently asked questions
Does Braven Health require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair?
Yes. Braven Health generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
What does Braven Health require to approve Shoulder Arthroscopy Rotator Cuff Repair?
Prior authorization required (rotator cuff repair is an orthopedic service under TurningPoint). Documented standard: conservative therapy first; PT notes plus imaging required. CONFIRM that CPT 29827 appears on TurningPoint's orthopedic code list (the public list did not render at sourcing); treat as PA-required and verify. Exact thresholds in TurningPoint policy library. Always confirm against the current Braven Health policy.
How long does a Braven Health prior authorization take?
Turnaround varies by plan and submission method. Check the Braven Health portal for current timeframes.
Submitting Shoulder Arthroscopy Rotator Cuff Repair to Braven 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.