P2P Call Guide

How to Win a P2P Call for Shoulder Arthroscopy / Rotator Cuff Repair Denied by MA Plans

Payer-specific strategy, medical necessity arguments, and the exact phrases to use when Medicare Advantage denies Shoulder Arthroscopy / Rotator Cuff Repair (CPT 29827, 29826, 23412).

Why MA Plans Denies Shoulder Arthroscopy / Rotator Cuff Repair

Conservative therapy not exhausted (PT, injections)

Partial tear does not meet surgical threshold

Imaging does not correlate with symptoms

Know Medicare Advantage's Criteria

Medicare Advantage plans must cover all services covered by Original Medicare (CMS NCDs and LCDs) but may require prior auth. Plans use various criteria including InterQual, MCG, and proprietary guidelines.

Key policies to know:

  • Must cover all services covered by Original Medicare
  • Can require prior authorization not required by Original Medicare
  • CMS NCDs and LCDs serve as coverage floor
  • Organization determinations must be issued within 14 days (72 hours for expedited)

Building Your Medical Necessity Argument

Document tear size and location on MRI

Show failure of 3-6 months PT and at least one subacromial injection

Note functional limitations and pain severity

Reference full-thickness tear or significant partial tear (>50%)

P2P Call Tips for MA Plans

Cite the relevant CMS NCD or LCD -- MA plans cannot deny what Medicare covers

If the service has a CMS NCD, that trumps the MA plan's internal criteria

Reference CMS regulations on MA coverage obligations

Request expedited determination if clinical urgency exists

Guidelines to Reference

  • AAOS Clinical Practice Guidelines for Rotator Cuff
  • AIM Specialty Health Shoulder Surgery Guidelines

Relevant CPT Codes

CPT 29827CPT 29826CPT 23412

Specialty: Orthopedics

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