Cigna Shoulder Arthroplasty Including Revision Procedures prior authorization requirements (2026)
What Cigna generally requires to approve Shoulder Arthroplasty Including Revision Procedures (CPT 23470, 23472, 23473, 23474), for Commercial plans. Yes. Cigna generally requires prior authorization for Shoulder Arthroplasty Including Revision Procedures (CPT 23470, 23472, 23473, 23474).
Medical-necessity criteria Cigna generally applies
Cigna administers shoulder arthroplasty prior authorization through eviCore CMM-318 (Shoulder Arthroplasty). Total or reverse shoulder arthroplasty may be considered medically necessary for documented glenohumeral osteoarthritis or rotator-cuff-tear arthropathy with radiographic confirmation, disabling pain and functional limitation, and failed appropriate non-operative care, per the indications defined in CMM-318.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Shoulder Arthroplasty Including Revision Procedures. Confirm the covered diagnosis list against the current Cigna policy.
Sources & verification
- BindingPayer medical policy.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 2026-06-13.
Frequently asked questions
Does Cigna require prior authorization for Shoulder Arthroplasty Including Revision Procedures?
Yes. Cigna generally requires prior authorization for Shoulder Arthroplasty Including Revision Procedures (CPT 23470, 23472, 23473, 23474).
What does Cigna require to approve Shoulder Arthroplasty Including Revision Procedures?
Cigna administers shoulder arthroplasty prior authorization through eviCore CMM-318 (Shoulder Arthroplasty). Total or reverse shoulder arthroplasty may be considered medically necessary for documented glenohumeral osteoarthritis or rotator-cuff-tear arthropathy with radiographic confirmation, disabling pain and functional limitation, and failed appropriate non-operative care, per the indications d… Always confirm against the current Cigna policy.
How long does a Cigna prior authorization take?
Turnaround varies by plan and submission method. Check the Cigna portal for current timeframes.
Submitting Shoulder Arthroplasty Including Revision Procedures to Cigna?
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.