TRICARE Shoulder Arthroscopy Rotator Cuff Repair prior authorization requirements (2026)
What TRICARE generally requires to approve Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827), for tricare plans. Based on the cited policy, TRICARE does not generally require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827). Confirm with TRICARE, as this can vary by plan.
Medical-necessity criteria TRICARE generally applies
No mandatory prior authorization; TRICARE Prime requires a referral. Covered per TPM Section 6.1 (note: microfracture for the shoulder is "unproven").
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 TRICARE policy.
How to submit
- Method: Humana Military self-service
- Portal: Humana Military
Sources & verification
- BindingSource — TRICARE Policy Manual 6010.60-M, Ch 4 Sec 6.1 (Musculoskeletal) · effective 2022-05-24.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 TRICARE require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair?
Based on the cited policy, TRICARE does not generally require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827). Confirm with TRICARE, as this can vary by plan.
What does TRICARE require to approve Shoulder Arthroscopy Rotator Cuff Repair?
No mandatory prior authorization; TRICARE Prime requires a referral. Covered per TPM Section 6.1 (note: microfracture for the shoulder is "unproven"). Always confirm against the current TRICARE policy.
How long does a TRICARE prior authorization take?
Turnaround varies by plan and submission method. Check the TRICARE portal for current timeframes.
Submitting Shoulder Arthroscopy Rotator Cuff Repair to TRICARE?
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.