Clover Health Shoulder Arthroscopy Rotator Cuff Repair prior authorization requirements (2026)
What Clover Health generally requires to approve Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827), for medicare_advantage plans. Yes. Clover Health generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
Medical-necessity criteria Clover Health generally applies
Prior authorization required via eviCore (MSK/joint surgery). Conservative-care and imaging documentation expected.
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 Clover Health policy.
How to submit
- Method: eviCore portal
- Portal: eviCore (by Evernorth)
Sources & verification
- BindingSource — Clover Health — Interventional Pain, Spine and Joint Surgeries (eviCore).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 2026-06-25.
Frequently asked questions
Does Clover Health require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair?
Yes. Clover Health generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
What does Clover Health require to approve Shoulder Arthroscopy Rotator Cuff Repair?
Prior authorization required via eviCore (MSK/joint surgery). Conservative-care and imaging documentation expected. Always confirm against the current Clover Health policy.
How long does a Clover Health prior authorization take?
Turnaround varies by plan and submission method. Check the Clover Health portal for current timeframes.
Submitting Shoulder Arthroscopy Rotator Cuff Repair to Clover 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.