Priority Health Shoulder Arthroscopy Rotator Cuff Repair prior authorization requirements (2026)
What Priority Health generally requires to approve Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827), for commercial plans. Yes. Priority Health generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
Medical-necessity criteria Priority Health generally applies
Prior authorization required via TurningPoint — MSK list explicitly includes "Acromioplasty and rotator cuff repair." Exact thresholds in the TurningPoint portal Policies tab.
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 Priority Health policy.
How to submit
- Method: prism → TurningPoint (myturningpoint-healthcare.com)
- Portal: TurningPoint Healthcare Solutions
Sources & verification
- BindingSource — TurningPoint Provider Guide — orthopedic surgical procedures (rotator cuff) · effective 2024-09-01.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 Priority Health require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair?
Yes. Priority Health generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
What does Priority Health require to approve Shoulder Arthroscopy Rotator Cuff Repair?
Prior authorization required via TurningPoint — MSK list explicitly includes "Acromioplasty and rotator cuff repair." Exact thresholds in the TurningPoint portal Policies tab. Always confirm against the current Priority Health policy.
How long does a Priority Health prior authorization take?
Turnaround varies by plan and submission method. Check the Priority Health portal for current timeframes.
Submitting Shoulder Arthroscopy Rotator Cuff Repair to Priority 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.