What insurance policy changes affect CPT 29825?

There are 9 tracked policy changes affecting CPT 29825, including updates from Humana, Providence Health Plan, Capital Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 29825?

Payers that have issued tracked updates for CPT 29825 include: Humana, Providence Health Plan, Capital Blue Cross.

How do I get notified when CPT 29825 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 29825. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 29825?

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.

29825 — Surgery to repair or tighten loose ligaments and other structures in the shoulder joint.: Insurance Policy Changes

29825 Insurance Policy Changes

CPT 29825, in plain terms, covers Surgery to repair or tighten loose ligaments and other structures in the shoulder joint. CPT 29825 is referenced in 9 tracked payer policy changes from Humana, Providence Health Plan, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 29825 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 May 2026 UPDATE - Outpatient Surgical Site of Service Notice

Providence Health Plan·Effective May 11, 2026

Effective May 11, 2026, Providence Health Plan will add a new medical necessity review specifically for the site of service (hospital outpatient vs. ASC) for knee arthroscopy, shoulder arthroscopy, and small joint surgery procedures on commercial fully insured groups. If medical policy criteria are not met for hospital outpatient placement, the procedure must be performed at an ASC for coverage. Providers must either have a signed attestation on file or indicate on the prior authorization request if no geographically accessible ASC is available.

29825 Insurance Policy Changes

Shoulder Arthroscopy - Medicare Advantage (Revised)

Special Alert March 2026 - 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

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)