What insurance policy changes affect CPT 29828?

There are 7 tracked policy changes affecting CPT 29828, 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 29828?

Payers that have issued tracked updates for CPT 29828 include: Providence Health Plan, Capital Blue Cross, Humana, Sentara Health Plans.

How do I get notified when CPT 29828 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 29828. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 29828?

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.

29828 — A surgical procedure to reattach or secure the biceps tendon in the shoulder joint.: Insurance Policy Changes

29828 Insurance Policy Changes

CPT 29828, in plain terms, covers A surgical procedure to reattach or secure the biceps tendon in the shoulder joint. CPT 29828 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 29828 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.

29828 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)

Authorization Updates - Effective January 1, 2026