Cigna Shoulder Arthroscopy Rotator Cuff Repair prior authorization requirements (2026)
What Cigna generally requires to approve Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827), for PPO, HMO plans. Yes. Cigna generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
Medical-necessity criteria Cigna generally applies
Per Cigna CCP 0070: Symptomatic full-thickness or significant partial-thickness rotator cuff tear confirmed on MRI/MR arthrogram or ultrasound. Failure of minimum 6 weeks conservative therapy (PT, NSAIDs, activity modification, +/- corticosteroid injection) unless acute traumatic tear in active patient. Documented pain and functional limitation (ROM deficits, weakness on exam).
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 Cigna policy.
Commonly required documentation
- H&P with shoulder exam (ROM, strength, impingement signs), MRI/US report confirming tear, conservative care records (PT notes, injection dates, medication trial), operative plan, CPT/ICD-10 codes, prior imaging reports
How to submit
- Method: portal
- Portal: Cigna for Health Care Professionals
- Typical turnaround: about 5 days
Source
Cigna uses internal CCP 0070 for shoulder surgery; not delegated to Carelon/eviCore. Out-of-network allowed at reduced benefit. Last verified 2026-05-18.
Frequently asked questions
Does Cigna require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair?
Yes. Cigna generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
What does Cigna require to approve Shoulder Arthroscopy Rotator Cuff Repair?
Per Cigna CCP 0070: Symptomatic full-thickness or significant partial-thickness rotator cuff tear confirmed on MRI/MR arthrogram or ultrasound. Failure of minimum 6 weeks conservative therapy (PT, NSAIDs, activity modification, +/- corticosteroid injection) unless acute traumatic tear in active patient. Documented pain and functional limitation (ROM deficits, weakness on exam). Always confirm against the current Cigna policy.
How long does a Cigna prior authorization take?
Cigna typically decides Shoulder Arthroscopy Rotator Cuff Repair requests in about 5 days. Timeframes vary; check the payer portal.
Submitting Shoulder Arthroscopy Rotator Cuff Repair 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.