UnitedHealthcare Shoulder Arthroscopy Rotator Cuff Repair prior authorization requirements (2026)
What UnitedHealthcare generally requires to approve Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827), for Commercial plans. Yes. UnitedHealthcare generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
Medical-necessity criteria UnitedHealthcare generally applies
UnitedHealthcare reviews shoulder arthroscopy and rotator cuff repair against InterQual CP: Procedures (Arthroscopy or Arthroscopically Assisted Surgery, Shoulder), policy 2026T0556FF (Surgery of the Shoulder). Subacromial balloon spacers for rotator cuff tears are unproven and not medically necessary. Specific thresholds (symptomatic rotator cuff tear, failed conservative care) are adjudicated via InterQual.
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 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 Arthroscopy Rotator Cuff Repair?
Yes. UnitedHealthcare generally requires prior authorization for Shoulder Arthroscopy Rotator Cuff Repair (CPT 29827).
What does UnitedHealthcare require to approve Shoulder Arthroscopy Rotator Cuff Repair?
UnitedHealthcare reviews shoulder arthroscopy and rotator cuff repair against InterQual CP: Procedures (Arthroscopy or Arthroscopically Assisted Surgery, Shoulder), policy 2026T0556FF (Surgery of the Shoulder). Subacromial balloon spacers for rotator cuff tears are unproven and not medically necessary. Specific thresholds (symptomatic rotator cuff tear, failed conservative care) are adjudicated vi… 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 Arthroscopy Rotator Cuff Repair 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.