CommercialCoverageMedium impact
Balloon Spacers for Treatment of Irreparable Rotator Cuffs of the Shoulder (7.01.180)
Blue Shield of California·CA · Orthopedics, Sports Medicine·Medical Policy
Effective date
Jul 1, 2025
We identified it
Jul 1, 2025
Summary
Blue Shield of California has classified subacromial balloon spacer implantation for massive, irreparable rotator cuff tears as investigational and not covered. This affects orthopedic procedures using balloon spacers like the InSpace system for shoulder rotator cuff treatment.
Action Required
By July 1, 2025: Billing team must update systems to flag subacromial balloon spacer implantation procedures as investigational/non-covered for Blue Shield of California members. Providers should be notified that these procedures will be denied and patients must be informed of non-coverage before treatment. Consider alternative covered treatments like partial repair, tendon transfers, or reverse shoulder arthroplasty.