NY State Workers' Comp Shoulder Arthroscopy Rotator Cuff Repair prior authorization requirements (2026)
What NY State Workers' Comp generally requires to approve Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827), for workers_comp plans. Based on the cited policy, NY State Workers' Comp does not generally require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827). Confirm with NY State Workers' Comp, as this can vary by plan.
Medical-necessity criteria NY State Workers' Comp generally applies
Authorized when consistent with the NY WC Shoulder Injury MTG (Table 3 rotator cuff repair: full-thickness tear with pain/weakness, imaging-confirmed, conservative care done if recommended); file an MTG Variance via OnBoard if out-of-guideline.
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 NY State Workers' Comp policy.
How to submit
- Method: OnBoard PAR
- Portal: NY WCB OnBoard
Sources & verification
- BindingSource — NY WCB Shoulder Injury Medical Treatment Guidelines · effective 2022-05-02.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 NY State Workers' Comp require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair?
Based on the cited policy, NY State Workers' Comp does not generally require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827). Confirm with NY State Workers' Comp, as this can vary by plan.
What does NY State Workers' Comp require to approve Shoulder Arthroscopy Rotator Cuff Repair?
Authorized when consistent with the NY WC Shoulder Injury MTG (Table 3 rotator cuff repair: full-thickness tear with pain/weakness, imaging-confirmed, conservative care done if recommended); file an MTG Variance via OnBoard if out-of-guideline. Always confirm against the current NY State Workers' Comp policy.
How long does a NY State Workers' Comp prior authorization take?
Turnaround varies by plan and submission method. Check the NY State Workers' Comp portal for current timeframes.
Submitting Shoulder Arthroscopy Rotator Cuff Repair to NY State Workers' Comp?
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.