UnitedHealthcare Shoulder Arthroplasty Including Revision Procedures prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve Shoulder Arthroplasty Including Revision Procedures (CPT 23470, 23472, 23473, 23474), for Commercial plans. Yes. UnitedHealthcare generally requires prior authorization for Shoulder Arthroplasty Including Revision Procedures (CPT 23470, 23472, 23473, 23474).
Medical-necessity criteria UnitedHealthcare generally applies
UnitedHealthcare reviews shoulder arthroplasty and revision against InterQual CP: Procedures (Joint Replacement, Shoulder; Removal and Replacement or Revision, Joint Replacement, Shoulder), policy 2026T0556FF (Surgery of the Shoulder). Proven and medically necessary in certain circumstances; specific thresholds (failed conservative care, radiographic glenohumeral arthritis or cuff-tear arthropathy) are adjudicated via InterQual.
Diagnoses that commonly support medical necessity
ICD-10-CM diagnoses frequently associated with medical necessity for Shoulder Arthroplasty Including Revision Procedures. Confirm the covered diagnosis list against the current UnitedHealthcare policy.
Source
Summarized from UnitedHealthcare Commercial Medical Policy Surgery of the Shoulder (2026T0556FF, eff 2026-01-01). Source: View the source policy. Last verified 2026-06-13.
Frequently asked questions
Does UnitedHealthcare require prior authorization for Shoulder Arthroplasty Including Revision Procedures?
Yes. UnitedHealthcare generally requires prior authorization for Shoulder Arthroplasty Including Revision Procedures (CPT 23470, 23472, 23473, 23474).
What does UnitedHealthcare require to approve Shoulder Arthroplasty Including Revision Procedures?
UnitedHealthcare reviews shoulder arthroplasty and revision against InterQual CP: Procedures (Joint Replacement, Shoulder; Removal and Replacement or Revision, Joint Replacement, Shoulder), policy 2026T0556FF (Surgery of the Shoulder). Proven and medically necessary in certain circumstances; specific thresholds (failed conservative care, radiographic glenohumeral arthritis or cuff-tear arthropathy… Always confirm against the current UnitedHealthcare policy.
How long does a UnitedHealthcare prior authorization take?
Turnaround varies by plan and submission method. Check the UnitedHealthcare portal for current timeframes.
Submitting Shoulder Arthroplasty Including Revision Procedures to UnitedHealthcare?
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.