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Surgery of the Shoulder (for Idaho Only)
Effective date
Dec 1, 2026
Identified
Nov 7, 2026
Summary
Effective 2026-12-01, UnitedHealthcare Community Plan of Idaho revised its Surgery of the Shoulder medical policy for Idaho Medicaid members: medical necessity criteria now point to InterQual CP procedure criteria for shoulder arthroscopy, arthrotomy and joint replacement, and CPT 29805 was removed from the applicable codes. The policy also states that subacromial balloon spacers for rotator cuff tears are unproven and not medically necessary.
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What to do
Action · 4 steps
01By 2026-12-01: Billing team should stop scheduling and billing CPT 29805 for Idaho Community Plan Medicaid members and update charge entry so the code is no longer selected for those claims.
02Before scheduling shoulder arthroscopy, arthrotomy or joint replacement for these members, check the InterQual CP criteria the policy references and document how the case meets them, and confirm with the payer's prior authorization requirements in the prior auth tracker.
03Providers and front desk staff should be told that subacromial balloon spacers for rotator cuff tears are not covered for these members, so the practice does not schedule them or should discuss financial responsibility before proceeding where the source allows.
04Claims for these services without supporting documentation are likely to be denied, so attach the relevant clinical records to the chart before submission.
Codes mentioned
29805
Original notice
Surgery of the Shoulder (for Idaho Only)
uhcprovider.com · Always check the source before changing claims.
Related changes
See all UnitedHealthcare changes →Outpatient Surgical Procedures – Site of ServiceMediumEffective Dec 1, 2026 · Medical PolicyOutpatient Surgical Procedures – Site of ServiceMediumEffective Dec 1, 2026 · Medical PolicyOutpatient Surgical Procedures – Site of ServiceMediumEffective Dec 1, 2026 · Medical PolicySurgery of the Shoulder (for Tennessee Only)HighEffective Oct 1, 2026 · Medical PolicyBrowse every UnitedHealthcare change in the policy list