What insurance policy changes affect CPT 29806?

There are 7 tracked policy changes affecting CPT 29806, including updates from Providence Health Plan, Capital Blue Cross, Humana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 29806?

Payers that have issued tracked updates for CPT 29806 include: Providence Health Plan, Capital Blue Cross, Humana, Blue Cross Blue Shield of Rhode Island.

How do I get notified when CPT 29806 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 29806. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 29806?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

29806 — A surgical procedure to tighten and repair the shoulder joint's protective capsule to improve stability.: Insurance Policy Changes

29806 Insurance Policy Changes

CPT 29806, in plain terms, covers A surgical procedure to tighten and repair the shoulder joint's protective capsule to improve stability. CPT 29806 is referenced in 7 tracked payer policy changes from Providence Health Plan, Capital Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 29806 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Special Alert March 2026 - Outpatient Surgical Site of Service Notice

Providence Health Plan·Effective May 11, 2026

Effective May 11, 2026, Providence Health Plan (Commercial Fully Insured Groups only) will now require medical necessity review for hospital outpatient surgical site of service (place of service 22) for knee arthroscopy, shoulder arthroscopy, and small joint surgery procedures. If medical policy criteria are not met for outpatient hospital setting, the procedure must be performed at an ASC instead. Providers without ASC access must submit signed attestation or note ASC unavailability on prior authorization requests.

29806 Insurance Policy Changes

Special Alert March 2026 - Outpatient Surgical Site of Service Notice

Special Alert May 2026 UPDATE - Outpatient Surgical Site of Service Notice

Special Alert May 2026 UPDATE - Outpatient Surgical Site of Service Notice

Special Alert March 2026 - Outpatient Surgical Site of Service Notice

AB2026-03-001 Updates and new information

Shoulder Arthroscopy - Medicare Advantage (New)

Medical policy updates