UMR Shoulder Arthroscopy Rotator Cuff Repair prior authorization requirements (2026)
What UMR generally requires to approve Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827), for commercial plans. Prior authorization requirements vary by plan. Confirm with UMR for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
Medical-necessity criteria UMR generally applies
Governed by UHC/UMR Medical Policy (and a Site-of-Service policy may apply). PA requirement is plan/employer-group-specific — verify with the per-member PA tool on umr.com. Rotator cuff repair was not on a sampled employer-group preauth list, illustrating that lists vary by group.
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 UMR policy.
How to submit
- Method: UMR provider portal (per-member PA tool)
- Portal: UMR
Sources & verification
- BindingSource — UMR Medical & Drug Policies (UHC-published) + UMR per-member Prior Authorization tool.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 UMR require prior authorization for Shoulder Arthroscopy Rotator Cuff Repair?
Prior authorization requirements vary by plan. Confirm with UMR for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
What does UMR require to approve Shoulder Arthroscopy Rotator Cuff Repair?
Governed by UHC/UMR Medical Policy (and a Site-of-Service policy may apply). PA requirement is plan/employer-group-specific — verify with the per-member PA tool on umr.com. Rotator cuff repair was not on a sampled employer-group preauth list, illustrating that lists vary by group. Always confirm against the current UMR policy.
How long does a UMR prior authorization take?
Turnaround varies by plan and submission method. Check the UMR portal for current timeframes.
Submitting Shoulder Arthroscopy Rotator Cuff Repair to UMR?
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.