Medicare AdvantageCoverageLow impact
Shoulder Arthroplasty - Medicare Advantage (Revised)
Humana·Orthopedics, Sports Medicine·Medicare Advantage
We identified it
Aug 4, 2026
Summary
This is a new Medicare Advantage policy summary for shoulder arthroplasty (replacement) surgery that describes the procedure and its clinical goals. However, the policy content provided is definitional only and does not contain specific billing guidance, prior authorization requirements, coverage limitations, or billing code information needed for implementation.
Action Required
IMMEDIATE: Billing team should contact Humana Medicare Advantage directly at the provided URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a591de6) to obtain the FULL policy document. The summary-only content provided is insufficient for billing operations. Request complete policy details including: specific CPT codes covered, prior authorization requirements, medical necessity criteria, and effective date. Do not implement billing changes based on this summary alone. Flag this policy in your tracking system as 'AWAITING FULL POLICY DETAILS' until complete documentation is received.