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GOHEALTHCARE MSK SPECIALTY PROCEDURE LIBRARY™

Labral Repair

Operational, Documentation, Medical Necessity, and Prior Authorization
Guide for MSK Specialty Practices, ASCs, and Hospital Outpatient
Departments

Document Profile

AttributeDetail
ProcedureLabral Repair (arthroscopic and open repair of the glenoid labrum, including SLAP repair, Bankart repair, and instability capsulorrhaphy)
LibraryGoHealthcare MSK Specialty Procedure Library™
StandardGoHealthcare Clinical Procedure Guide Standard v1.0
SpecialtyOrthopedic Surgery · Sports Medicine · Shoulder Instability
Primary CPT® codes29806 (arthroscopic capsulorrhaphy); 29807 (SLAP repair); 23450–23466 (open capsulorrhaphy family); 29999 (unlisted)
SettingAmbulatory Surgery Center (POS 24) · Hospital Outpatient (POS 22)
Version / Date1.1 · July 2026 (independent second-pass audit applied)
AuthorPinky Maniri, MSc, CRCR, CSAPM, CSPPM, CSBI, CSPR, CSAF · Certified in Healthcare A.I. Governance · Founder & Chief Executive Officer, GoHealthcare Practice Solutions

Contents

1. Evidence at a Glance2. Overview3. Relevant Anatomy (High-Level Overview)4. Clinical Indications5. Patient Selection6. Contraindications7. Conservative Treatment Requirements8. Imaging Requirements9. Medical Necessity10. Medicare Coverage11. Commercial Payer Comparison12. Prior Authorization Workflow13. Documentation Requirements14. Common Prior Authorization Denials15. Appeal Strategies16. Coding & Billing Overview17. Implants, Devices, and System Considerations18. Clinical Documentation Checklist (Operative Note)19. Procedure Comparison20. GoHealthcare Clinical Insights21. GoHealthcare Leadership Perspective22. GoHealthcare Prior Authorization Insight23. GoHealthcare Case Study24. GoHealthcare Best Practices25. Common Mistakes26. Pearls and Pitfalls27. Frequently Asked Questions28. Key Takeaways29. Future Outlook30. References31. Reading Recommendations32. Related GoHealthcare Resources (Internal Links)33. Recommended Downloads34. Visual Recommendations35. Document History36. Educational Disclaimer
1

Evidence at a Glance

Labral repair is the most age- and history-sensitive procedure in the shoulder family. Two patients with identical MRI findings can face opposite coverage outcomes depending on age, number of dislocations, glenoid bone loss, and whether the lesion is superior (SLAP) or anteroinferior (Bankart). The authorization packet must therefore capture instability history with a precision that other shoulder procedures do not require.

DomainSummary
Medicare NCDNo National Coverage Determination specific to labral repair. General "reasonable and necessary" standard applies (Social Security Act 1862(a)(1)(A)).
Medicare LCD / MACNo dedicated national LCD. Traditional fee-for-service Medicare does not require prior authorization; post-payment medical review applies.
Commercial coverageCovered for symptomatic, imaging-confirmed labral pathology meeting instability or SLAP criteria. Managed via eviCore CMM-315, Carelon Joint Surgery, Cohere, Evolent/NIA CG-318, and TurningPoint.
DomainSummary
Prior authorizationRequired by most commercial plans and Medicare Advantage. The full open capsulorrhaphy family (23450–23466) plus 29806/29807 appears on essentially every vendor PA code list.
Evidence levelStrong for anteroinferior (Bankart) stabilization in recurrent instability, particularly in patients under 30. More contested for isolated SLAP repair in patients over 40, where biceps tenodesis or tenotomy is frequently preferred.
Image guidanceMR arthrography is the preferred study for labral pathology. CT or CT arthrography is used to quantify glenoid bone loss, which drives the choice between soft-tissue repair and bone-block procedures.
Conservative therapyGenerally required for degenerative and SLAP indications. Recurrent instability and, under several 2026 policies, first-time dislocation in patients under 30 are recognized exceptions.
Bone loss assessmentGlenoid bone loss and Hill-Sachs "on-track / off-track" status are the decisive variables separating an approvable soft-tissue repair from a bone-block or coracoid transfer request.
Key documentationAge at first dislocation, number of recurrences, mechanism, direction of instability, lesion location (superior vs. anteroinferior), bone loss quantification, and activity demands.
Typical approval driverA young patient with documented recurrent instability and a confirmed anteroinferior labral lesion approves readily. Denials cluster around isolated SLAP repair over age 40, remplissage, and bone-block procedures without quantified bone loss.
2

Overview

The glenoid labrum is a fibrocartilaginous rim that deepens the shallow glenoid socket and serves as the attachment for the capsuloligamentous structures and the long head of the biceps. Labral repair encompasses two clinically and operationally distinct problems that happen to share an anatomic structure: superior labral (SLAP) pathology at the biceps anchor, and anteroinferior labral (Bankart) pathology associated with glenohumeral instability.

These two problems have different patient populations, different evidence bases, different payer criteria, and different CPT® codes — yet they are frequently conflated in both documentation and coding. The most consequential operational discipline in this guide is keeping them separate.

The distinction that drives everything

29807 reports repair of a SLAP lesion — the superior labrum at the biceps anchor. 29806 reports capsulorrhaphy — the instability repair, which is how an arthroscopic Bankart procedure is coded. These target anatomically distinct regions and are not interchangeable. Reporting both for a single SLAP repair, where no separate capsular defect in a different area was addressed, is among the most frequently cited coding errors in shoulder surgery.

3

Relevant Anatomy (High-Level Overview)

  • Glenoid labrum: the fibrocartilaginous rim deepening the glenoid, described by clock-face position.
  • SLAP lesion: injury of the superior labrum extending anterior to posterior, involving the biceps anchor; often described as a tear between roughly the 10 o'clock and 2 o'clock positions.
  • Bankart lesion: detachment of the anteroinferior labrum from the glenoid rim, the classic lesion of recurrent anterior instability. A bony Bankart involves an associated glenoid rim fracture.
  • Hill-Sachs lesion: an impaction defect of the posterolateral humeral head created during anterior dislocation. Its size and position relative to the glenoid track determine whether it is "on-track" or "off-track" (engaging).
  • Glenoid bone loss: attritional loss of the anterior glenoid from recurrent dislocation. Beyond a critical threshold, soft-tissue repair alone carries a high failure rate and bone-augmenting procedures are considered.
  • Capsuloligamentous complex: the capsule and glenohumeral ligaments; capsular laxity or redundancy drives multidirectional instability, a distinct clinical entity.
  • Long head of biceps: originates at the superior labrum, which is why SLAP pathology and biceps pathology are clinically inseparable and frequently treated together.
4

Clinical Indications

  • Recurrent anterior glenohumeral instability with an imaging-confirmed anteroinferior (Bankart) labral lesion.
  • First-time traumatic anterior dislocation in a young, high-demand patient, where recurrence risk is high — increasingly recognized in policy as an exception to required non-operative treatment.
  • Symptomatic posterior instability with posterior labral pathology.
  • Multidirectional instability refractory to a structured rehabilitation program.
  • Symptomatic type II SLAP lesion in a younger patient, particularly an overhead athlete, after failed conservative care.
  • Bony Bankart lesion requiring fragment reduction and fixation.
  • Recurrent instability with significant glenoid bone loss or an off-track Hill-Sachs lesion, where bone-block or coracoid transfer procedures are considered.
  • Failed prior stabilization requiring revision.
5

Patient Selection

Labral repair authorization turns on variables that are frequently absent from a standard shoulder note. Capture each of these explicitly at intake:

VariableWhy it matters operationally
Age at first dislocationPatients under 30 carry a high recurrence rate, which supports earlier stabilization and, under several 2026 policies, exempts them from the standard non-operative trial.
Number of recurrencesDistinguishes a first-time dislocator from established recurrent instability — different criteria pathways.
Direction of instabilityAnterior, posterior, or multidirectional determines the applicable code and criteria set.
Lesion locationSuperior (SLAP) versus anteroinferior (Bankart) determines whether 29807 or 29806 applies.
Glenoid bone lossQuantified bone loss determines whether soft-tissue repair is defensible or a bone-block/coracoid transfer is indicated.
Hill-Sachs track statusOn-track versus off-track drives the decision to add remplissage — a procedure with no Category I code and frequent payer denial.
Age (SLAP cases)Isolated SLAP repair in patients over 40 shows higher failure and stiffness rates; biceps tenodesis or tenotomy is often the preferred and better-covered alternative.
Activity demandsContact athletes and overhead athletes are weighted differently in several criteria sets.
6

Contraindications

  • Active local or systemic infection; medical instability precluding safe surgery.
  • Glenoid bone loss beyond the threshold at which isolated soft-tissue repair is expected to fail — a contraindication to the procedure selected, not to surgery.
  • Voluntary or habitual instability with a significant behavioral component, which historically responds poorly to stabilization.
  • Untreated seizure disorder or other condition driving recurrent dislocation.
  • Established glenohumeral arthritis where stabilization will not address the primary problem.
  • Asymptomatic labral changes identified incidentally on imaging — a common finding in older patients and a frequent denial scenario.
  • For isolated SLAP repair: advanced age with degenerative biceps anchor changes, where tenodesis or tenotomy is the more appropriate pathway.
7

Conservative Treatment Requirements

ElementWhat payers look for
DurationCommonly 6 weeks to 3 months of documented non-operative care for SLAP, degenerative, and multidirectional indications, with explicit dates.
Physical therapyA structured program emphasizing rotator cuff and periscapular strengthening and proprioceptive retraining; multidirectional instability in particular is expected to have a substantial rehabilitation trial.
Activity modificationDocumented, and now explicitly paired with joint-conservation techniques under 2026 TurningPoint policy language.
Recurrent instability exceptionEstablished recurrent traumatic instability with a structural Bankart lesion generally does not require a prolonged trial; document the recurrence history instead.
First-time dislocation under 30TurningPoint's 2026 updates added first-time dislocation in an individual under age 30 to the exclusions from required non-operative treatment for capsulorrhaphy/Bankart procedures. Verify the specific plan's current position.
Documented failureWhere a trial is required, state that it was completed and did not produce durable stability or function.
8

Imaging Requirements

  • Plain radiographs including instability-specific views to assess glenoid rim fracture, Hill-Sachs lesion, and arthritis.
  • MR arthrography is the preferred study for labral pathology; sensitivity for both SLAP and Bankart lesions is materially higher than non-contrast MRI.
  • CT or CT arthrography is the standard for quantifying glenoid bone loss and characterizing bony Bankart fragments — and is effectively required when a bone-block or coracoid transfer procedure is requested.
  • Glenoid track assessment (on-track vs. off-track) should be documented when remplissage or a bone procedure is contemplated, as it is the clinical justification reviewers look for.
  • Imaging must correlate with the specific lesion location. A request for SLAP repair supported by imaging describing only an anteroinferior lesion — or the reverse — is a predictable denial.
9

Medical Necessity

PillarDocumentation that demonstrates it
Instability historyAge at first dislocation, number and mechanism of recurrences, direction, and any requirement for reduction.
Symptoms & functionPain, apprehension, mechanical symptoms, and functional limitation in work, sport, and ADLs.
Objective findingsApprehension, relocation, load-and-shift, and sulcus testing as applicable, compared with the contralateral side.
Imaging correlationMR arthrogram naming the specific labral lesion and its location; CT quantifying bone loss where a bone procedure is requested.
Conservative care or exceptionDated trial with outcome, or an explicitly stated recurrent-instability or young first-time-dislocator exception.
10

Medicare Coverage

  • No NCD and no dedicated national LCD govern labral repair; coverage rests on the general reasonable-and-necessary standard with MAC medical review.
  • Traditional Medicare requires no prior authorization, and labral repair is not part of the Hospital Outpatient Department prior-authorization program.
  • Medicare Advantage plans routinely require prior authorization and commonly delegate to eviCore, Carelon, Cohere, Evolent/NIA, or TurningPoint.
  • Population note: primary instability repair is uncommon in the traditional Medicare population; Medicare-age labral presentations are more often degenerative and are frequently managed with debridement or biceps procedures rather than repair. Requests for repair in this population should anticipate closer scrutiny.
  • Post-payment exposure concentrates on 29806 reported with 29807, and on unlisted-code claims for remplissage or arthroscopic coracoid transfer.
11

Commercial Payer Comparison

Payer / vendorHow labral repair is managed (summary)
eviCore by EvernorthCMM-315 (Shoulder Surgery — Arthroscopic and Open Procedures) governs labral and instability procedures. The current eviCore MSK Joint CPT® list (effective 02/01/2026) carries the full open capsulorrhaphy family 23450, 23455, 23460, 23462, 23465, 23466 as PA-required.
Carelon Medical Benefits MgmtJoint Surgery guideline, with the same capsulorrhaphy code family on its MSK procedure code list. Critical bundling: all arthroscopic shoulder procedures are inclusive of diagnostic arthroscopy and manipulation under anesthesia.
Cohere HealthMSK surgical authorization platform used by several plans including Humana lines. Instability history and imaging correlation are the determinative fields.
Evolent / NIAGuideline NIA CG 318 defines a discrete "Shoulder Labral Repair" code group: 23450, 23455, _ _ 23460, 23462, 23465, 23466, 29806, 29807, with a UM matrix of allowable billed groupings. Its guidance notes that symptomatic Bankart lesions typically require repair because patients under 30 have a high instability recurrence rate.
TurningPointDelegated surgical PA on many plans. 2026 MSK policy updates added first-time dislocation in an individual under age 30 to the exclusions from required non-operative treatment for capsulorrhaphy and Bankart procedures, and added joint-conservation techniques to non-operative requirements.
HealthHelpAdministers PA for certain Blue Cross Blue Shield plans and lists the full capsulorrhaphy family as PA-required — a reminder that vendor identification cannot be assumed from the plan name.
UnitedHealthcare / Aetna / Cigna / HumanaEach maintains shoulder surgery medical policy or delegates to a vendor; Cigna managed lines run through eviCore CMM-315. Confirm the current PA list and vendor by plan.
Blue Cross Blue Shield plansVary by licensee; delegation may run to Carelon, eviCore, TurningPoint, or HealthHelp. Verify per plan, per cycle.
Payer guideline currency Currency note: eviCore's February 2026 policy update records that CMM-315 was revised with clinical changes that LIMIT coverage, effective 03/07/2026 — alongside CMM-311 (Knee Replacement) and CMM-313 (Hip Replacement). By contrast CMM-312, CMM-314, and CMM-318 were updated with no clinically impactful changes in that cycle. The Cigna commercial editions carry an effective date of 08/04/2026. Confirm the version in force at the time of service.
12

Prior Authorization Workflow

  • 1. Eligibility & vendor identification. Confirm which entity holds surgical PA — for this code family the vendor landscape is unusually varied.
  • 2. Classify the lesion. Superior (SLAP) or anteroinferior (Bankart) or multidirectional. This determines code, criteria set, and evidence posture.
  • 3. Build the instability history. Age at first dislocation, recurrence count, mechanism, direction, reductions required.
  • 4. Assess bone loss. If a bone-block or coracoid transfer is planned, obtain and quote CT quantification of glenoid bone loss and glenoid-track status.
  • 5. Flag adjunct procedures. Remplissage and arthroscopic coracoid transfer have no Category I code — identify them pre-service and expect manual review.
  • 6. Procedure mapping. Confirm the anticipated code(s) and whether 29806 and 29807 are both genuinely supported by distinct lesions.
  • 7. Medical-necessity statement. Lead with lesion location, instability history, and either the failed trial or the stated exception.
  • 8. Submit, track, confirm. Portal submission; respond to information requests within the vendor window; record authorization number, approved codes, and validity window.
13

Documentation Requirements

  • Age at first dislocation and patient's current age
  • Number of dislocation or subluxation episodes, with dates where available
  • Mechanism of injury and whether formal reduction was required
  • Direction of instability (anterior / posterior / multidirectional)
  • Specific labral lesion location (superior vs. anteroinferior vs. posterior)
  • Bony versus soft-tissue Bankart clearly distinguished
  • Glenoid bone loss quantification where a bone procedure is contemplated
  • Hill-Sachs presence and on-track / off-track assessment where remplissage is contemplated
  • Instability-specific examination findings versus the contralateral side
  • MR arthrogram report quoted, naming the lesion and its location
  • Dated conservative care with outcome, OR an explicitly stated exception
  • Activity demands (contact athlete, overhead athlete, occupational)
  • Laterality; prior ipsilateral stabilization surgery if any
14

Common Prior Authorization Denials

Denial reasonRoot cause / prevention
Instability history not documentedAge at first dislocation and recurrence count absent. Prevention: capture at intake as discrete fields.
SLAP repair in patient over 40Isolated SLAP repair requested where evidence favors tenodesis/tenotomy. Prevention: document why repair is preferred, or plan the better-supported alternative.
Imaging does not match lesionRequest for SLAP repair with imaging describing anteroinferior pathology, or the reverse. Prevention: quote the matching imaging sentence.
Bone procedure without bone loss quantificationBone-block or coracoid transfer requested without CT quantification. Prevention: obtain CT and quote the measurement.
Remplissage deniedNo Category I code; commonly denied outright. Prevention: identify pre-service, submit with operative rationale and glenoid-track documentation.
Insufficient conservative careTrial absent on a SLAP or multidirectional case. Prevention: dated entries, or claim a recognized instability exception.
Denial reasonRoot cause / prevention
Both 29806 and 29807 requestedTwo labral codes requested without two distinct lesions. Prevention: confirm distinct anatomic regions before submission.
15

Appeal Strategies

  • Answer the exact criterion cited — instability criteria are itemized, so respond item by item.
  • For conservative-care denials on recurrent instability, supply the recurrence history and cite the plan's own instability exception rather than manufacturing a retrospective trial.
  • For young first-time dislocators, cite the plan's current policy language on first-time dislocation under age 30 where it exists.
  • For bone-procedure denials, supply the CT quantification and glenoid-track assessment; these are objective and are usually what was missing.
  • For SLAP denials over age 40, recognize that the payer is applying an evidence-based preference for tenodesis; the productive response is often a revised operative plan rather than an appeal.
  • For unlisted-code denials (remplissage, arthroscopic coracoid transfer), submit the operative report with a comparison code and rationale — these are reviewed manually and rarely approved on a bare code.
  • Preserve internal and external appeal deadlines; medical-necessity disputes qualify for independent external review.
16

Coding & Billing Overview

Operational overview for authorization and revenue-cycle teams. All descriptors below were verified against current published CPT® code lists (including the eviCore MSK Joint list effective 02/01/2026), ABOS code listings, and ICD-10-CM FY2026. Detailed reimbursement methodology belongs in the GoHealthcare Revenue Cycle Knowledge Center.

Arthroscopic Labral / Instability Codes

CPT®DescriptorOperational notes
29806Arthroscopy, shoulder, surgical; capsulorrhaphyThe instability repair code — this is how an arthroscopic BANKART procedure is reported. Documentation may say "recurrent instability" or "recurrent dislocation" rather than "capsulorrhaphy."
29807Arthroscopy, shoulder, surgical; repair of SLAP lesionSuperior labrum anterior-posterior repair. Look for "SLAP," "superior labrum," or a tear described between roughly the 10 and 2 o'clock positions.
29999Unlisted procedure, arthroscopyApplies to remplissage and arthroscopic coracoid transfer, neither of which has a Category I code. Submit operative report with a comparison code.

Open Capsulorrhaphy Family (verified descriptors)

CPT®DescriptorCommon name
23450Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operationHistoric anterior capsulorrhaphy techniques
23455Capsulorrhaphy, anterior; with labral repair (eg, Bankart procedure)Open Bankart repair
23460Capsulorrhaphy, anterior, any type; with bone blockAnterior bone block / glenoid augmentation
23462Capsulorrhaphy, anterior, any type; with coracoid process transferLatarjet / Bristow procedure
23465Capsulorrhaphy, glenohumeral joint, posterior, with or without bone blockPosterior stabilization
23466Capsulorrhaphy, glenohumeral joint, any type multi-directional instabilityMultidirectional instability repair. Under AAOS global service data, 23466 INCLUDES the work of 23455 — do not report both.

Bundling: what 29806 and 29807 already include (AAOS global service data)

Per AAOS global service data guidance, 29806 includes the open capsulorrhaphy codes 23450, 23455, 23460, 23462, and 23465; shoulder dislocation treatment codes 23650, 23655, and 23660; manipulation of the shoulder joint (23700); and thermal capsular shrinkage. 29807 includes 23700. Both 29806 and 29807 include 29805, 29820, 29822, and 29825.

Two consequences follow. First, an open and an arthroscopic stabilization of the same shoulder should not be reported together. Second, 29807 does not include an open repair code — because there is no CPT® code for open repair of a SLAP lesion.

Important currency note: AAOS global service data and CMS NCCI edits do not always agree, and NCCI PTP edits with their modifier indicators are republished QUARTERLY. Verify the active CMS edit files rather than relying on cached tables or prior-quarter references — a pair that was separately reportable last quarter may not be this quarter.

Reporting 29806 and 29807 Together — A Genuine AAOS / NCCI Conflict

This is the most consequential unresolved coding question in the labral family, and published guidance genuinely conflicts. Practices must know which rule their payer follows.

AuthorityPosition
NCCI (CMS)NCCI bundles 29806 and 29807 and permits only ONE per shoulder, per session. NCCI Chapter 4 guidelines state that the shoulder is a single anatomic structure and instruct that a modifier NOT be used to unbundle arthroscopic shoulder procedures performed on the same shoulder. For Medicare and other federally funded programs (Medicaid, federal BCBS, CHAMPVA, TRICARE), the combination will be denied.
AAOS global service dataTakes the opposite position: both codes are reportable with appropriate supporting diagnoses when two anatomically distinct repairs are performed.
AAOS Bulletin (practical)Where both the upper and lower halves of the labrum are repaired in the same session, append modifier 22 to the single reported code to reflect the additional work — rather than reporting both codes.
Operational position For Medicare and federally funded programs, report ONE labral code per shoulder per session and use modifier 22 with supporting operative-note detail where both halves of the labrum were repaired. Do not attempt to unbundle 29806 and 29807 with modifier 59 on the same shoulder — NCCI Chapter 4 identifies this as improper and it is a documented audit trigger. For commercial payers that follow AAOS global service data rather than NCCI, confirm the payer position in writing before adopting a two-code billing practice. Reporting both codes for a single SLAP repair, with no separate lower-labral work, is incorrect under every authority.

Procedures Without a Category I Code

ProcedureCoding approachNotes
Remplissage (Hill-Sachs)29806 with modifier 22, or 29999No Category I code, and authorities conflict: AAOS considers remplissage INCLUSIVE to the Bankart repair, while AHA Coding Clinic for HCPCS (third quarter 2016) advises reporting 29999 in conjunction with 29806 when both labral repair and remplissage are performed. Payers commonly deny remplissage; flag pre-service and confirm the payer position.
Arthroscopic coracoid transfer29999The open Latarjet has a code (23462); the arthroscopic version does not. Submit operative report with comparison code.
Bony Bankart (arthroscopic)29806 with modifier 22, or 29999Published specialty guidance suggests 29806 with modifier 22 where labral repair serves as the indirect reduction maneuver for the glenoid rim fragment; 29999 may also be considered.

Common ICD-10-CM Diagnosis Codes (FY2026, verified)

ICD-10-CMDescriptionCoding note
S43.431A / S43.432ASuperior glenoid labrum lesion, right / left shoulder, initial encounterThe SLAP code. 7th character A (initial), D (subsequent), S (sequela). Supports 29807.
M24.411 / M24.412Recurrent dislocation, right / left shoulderThe instability workhorse; supports 29806 and the open capsulorrhaphy family.
M75.81 / M75.82Other shoulder lesions, right / leftDegenerative, non-traumatic labral pathology. ICD-10-CM has NO M75.6- code, despite its circulation by non-authoritative sources.
S43.0- familySubluxation and dislocation of shoulder jointBranches by direction (anterior, posterior, inferior) and laterality, with 7th character A/D/S. Select the specific code matching the documented direction and encounter.
S42.14- familyFracture of glenoid cavity of scapula (e.g. S42.141 right, S42.142 left, with 7th character)The correct family for a BONY BANKART (glenoid rim fracture). CAUTION: some circulating coding content points to the S42.2- series — that is fracture of the UPPER END OF THE HUMERUS, a different bone. Do not use it for a glenoid rim fracture.
M25.311 / M25.312Other instability, right / left shoulderWhere instability is documented without a specific recurrent-dislocation diagnosis.
M75.21 / M75.22Bicipital tendinitis, right / leftFrequently concurrent with SLAP pathology. NOT M77.1- (epicondylitis).
M25.511 / M25.512Pain in shoulder, right / leftNon-specific; do not rely on alone.

Applicable Modifiers and Place of Service

ModifierUse
RT / LTLaterality; append per payer requirement.
59 / X{EPSU}Distinct procedural service. CAUTION: NCCI Chapter 4 treats the shoulder as a single anatomic structure and instructs that a modifier NOT be used to unbundle arthroscopic shoulder procedures on the same shoulder — including 29806 with 29807. Verify NCCI PTP edits and the modifier indicator in the CURRENT quarterly CMS files before use.
22Increased procedural services — the AAOS-advised vehicle for repair of BOTH halves of the labrum in one session (append to the single reported code), and for remplissage and certain bony Bankart repairs reported under 29806. Requires substantial operative-note support.
57Decision for surgery on a separately reportable E/M.
AS / 80 / 81 / 82Assistant-at-surgery, when documented and supported.
  • POS 24 (ASC) and POS 22 (on-campus hospital outpatient) are the standard settings.
  • Open bone-block and coracoid transfer procedures may carry different facility expectations than arthroscopic stabilization; confirm the authorization matches the rendered site of service.
  • Suture anchors and fixation are not separately reported on the physician professional claim.
17

Implants, Devices, and System Considerations

  • Suture anchors from Arthrex, DePuy Synthes (Mitek), Stryker, Smith+Nephew, Zimmer Biomet, and CONMED are the standard fixation for soft-tissue labral repair. Anchor brand does not change CPT® selection.
  • Knotless and all-suture anchors are widely used; document the construct in the operative note to support the reported repair.
  • Screw and button fixation is used for coracoid transfer and bone-block procedures; document the fixation method, which distinguishes these procedures from soft-tissue repair.
  • Bone graft sources for glenoid augmentation include coracoid autograft (Latarjet), iliac crest autograft, distal clavicle autograft, and allograft. The graft source affects the applicable code family — verify before coding.
  • Physician professional coding does not include separately reported implants; facility implant reporting follows facility contracts and reporting rules.
  • Where a novel fixation system or graft technology is used, confirm both the correct code and the payer's coverage position pre-service rather than assuming the base repair code covers it.
18

Clinical Documentation Checklist (Operative Note)

  • Laterality and approach (arthroscopic vs. open)
  • Specific labral region(s) repaired, described by clock-face position or anatomic region
  • Where both 29806 and 29807 are reported: each repair described independently, in different regions
  • Bony versus soft-tissue Bankart, and fragment fixation method if applicable
  • Capsular work performed (plication, shift, capsulorrhaphy) described distinctly from labral repair
  • Hill-Sachs lesion presence and, if remplissage performed, the technique and rationale
  • Glenoid bone loss encountered and any bone-augmenting procedure with graft source and fixation
  • Number and type of anchors or fixation devices used
  • Any concurrent biceps procedure, documented as distinct work
  • Findings supporting the reported diagnosis code and laterality
19

Procedure Comparison

PathwayTypical patientRepresentative codesAuthorization emphasis
Arthroscopic BankartRecurrent anterior instability, minimal bone loss29806Instability history; bone loss below threshold
Open BankartSelected or revision cases23455Approach must match operative note
SLAP repairYounger patient, overhead athlete29807Age; failed conservative care; matching imaging
Biceps tenodesis / tenotomySLAP pathology over ~4029828 / 23430Often the better-supported alternative
RemplissageOff-track Hill-Sachs29806 + mod 22, or 29999No Category I code; frequently denied
Bone blockSignificant glenoid bone loss23460CT quantification required
Latarjet (coracoid transfer)Critical bone loss, revision23462 open; 29999 arthroscopicCT quantification; approach determines code
Posterior / multidirectionalPosterior or MDI instability23465 / 23466Extended rehabilitation trial expected for MDI
20

GoHealthcare Clinical Insights

Operational recommendations from MSK authorization practice

  • Add four discrete fields to the shoulder intake template for instability cases: age at first dislocation, recurrence count, direction, and bone-loss status. These four fields resolve the majority of labral pends.
  • Classify SLAP versus Bankart at intake and route accordingly — they are different evidence bases and different criteria sets.
  • For any patient over 40 with isolated SLAP pathology, confirm the surgeon's rationale for repair over tenodesis before submitting; if repair is not clearly justified, the tenodesis pathway is both better supported and better covered.
  • Order and obtain CT bone-loss quantification before submitting any bone-block or coracoid transfer request; it is the single most common missing element.
  • Flag remplissage at scheduling. It has no Category I code, is frequently denied, and is often decided intra-operatively — the worst combination for revenue integrity.
  • Before reporting 29806 and 29807 together, have a coder confirm the operative note describes two distinct repairs in different regions.
21

GoHealthcare Leadership Perspective

Executive view

Labral repair is where a shoulder service line's documentation discipline is most visibly tested. Unlike rotator cuff repair, where a single imaging sentence usually carries the case, labral and instability authorization depends on a longitudinal history — age at first dislocation, recurrence count, direction, bone loss — that no imaging report supplies and that a standard shoulder template does not capture. Practices that have not restructured intake for this procedure experience a pend rate that looks like a payer problem but is actually a data-capture problem.

The second structural issue is the concentration of Category III and unlisted-code procedures in this family. Remplissage and arthroscopic coracoid transfer carry no Category I code, are often decided intra-operatively, and are frequently denied. Organizations should treat these as a defined escalation class with pre-service verification and, where appropriate, documented financial counseling — the same governance applied to augmentation technologies in rotator cuff repair. Applying a single generic authorization workflow across the whole labral family reliably produces avoidable denials on the highest-acuity cases.

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GoHealthcare Prior Authorization Insight

What we see that payer policies do not spell out

  • Four fields decide most labral cases: age at first dislocation, recurrence count, direction, bone loss. Build them into intake as structured fields, not narrative.
  • 29806 is the Bankart code. Surgeons rarely write "capsulorrhaphy." Train coders to read "recurrent instability" and "Bankart" as 29806, not 29807.
  • Age 40 is a real inflection point for SLAP. Payers apply the evidence favoring tenodesis. Anticipate it rather than appealing it.
  • Bone loss without a number is not bone loss. Reviewers want a CT measurement, not a narrative impression.
  • Remplissage is the highest-risk adjunct in this family — no Category I code, common denial, frequent intra-operative decision. Verify pre-service.
  • Vendor identification matters more here than elsewhere. This code family appears on eviCore, Carelon, Evolent/NIA, TurningPoint, and HealthHelp lists; the plan name does not predict the vendor.
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GoHealthcare Case Study

Educational scenario — details are illustrative and do not identify any actual patient or organization.

Clinical Scenario

A 24-year-old recreational contact athlete presents after a fourth right shoulder dislocation, the first at age 19. Examination demonstrates marked apprehension and a positive relocation test. MR arthrogram describes an anteroinferior labral tear with an associated Hill-Sachs lesion. The surgeon plans an arthroscopic Bankart repair and, depending on intra-operative engagement, possible remplissage.

Documentation Challenges

The initial request listed 29807 (SLAP repair) — selected because the coder saw "labral tear" and reached for the labral code — and did not state the recurrence count or age at first dislocation. No CT bone-loss quantification had been obtained, and the possible remplissage was not mentioned.

Prior Authorization Barriers

The vendor denied the request as unsupported: imaging described anteroinferior pathology while the requested code addressed the superior labrum. Even had the code been correct, the absent instability history would have pended the case, and the unquantified Hill-Sachs lesion left the contingent remplissage entirely unaddressed.

Payer Considerations

The plan's guideline supports stabilization in recurrent instability without a prolonged non-operative trial, given the documented recurrence history. Remplissage, having no Category I code, required separate manual review supported by glenoid-track documentation.

Resolution Strategy

  • Corrected the procedure code to 29806 (capsulorrhaphy), the arthroscopic Bankart code.
  • Added the instability history as structured data: first dislocation at age 19, four total episodes, anterior direction, contact-sport demands.
  • Coded the diagnosis as M24.411 (recurrent dislocation, right shoulder).
  • Quoted the MR arthrogram sentence naming the anteroinferior labral tear.
  • Obtained CT quantification of glenoid bone loss and an on-track/off-track assessment, and submitted a separate pre-service inquiry for contingent remplissage with that documentation attached.

Outcome

The Bankart repair was approved without a peer-to-peer on the corrected submission. The remplissage inquiry returned a determination requiring operative-report review post-service; the patient was counseled pre-operatively about that contingency, and the operative note was prepared accordingly. No unexpected liability arose.

Lessons Learned

  • "Labral tear" is not a code. The anatomic region — superior versus anteroinferior — determines whether 29807 or 29806 applies.
  • Instability history is the medical necessity in these cases; imaging alone does not carry the request.
  • Contingent adjuncts without Category I codes must be surfaced before the operating room, because that is the last point at which they can be verified.
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GoHealthcare Best Practices

  • Restructure shoulder intake to capture instability history as four discrete fields for every labral case.
  • Route SLAP and Bankart cases through separate criteria checklists.
  • Require CT bone-loss quantification before submitting any bone-block or coracoid transfer request.
  • Treat remplissage and arthroscopic coracoid transfer as a defined escalation class with pre-service verification.
  • Require coder confirmation before reporting 29806 and 29807 together.
  • Re-verify the plan's UM vendor each cycle; this code family has unusually varied delegation.
  • For SLAP patients over 40, confirm the operative rationale before submission rather than after denial.
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Common Mistakes

  • Reporting 29807 for an arthroscopic Bankart repair — the correct code is 29806.
  • Reporting 29806 and 29807 together for a single SLAP repair without separate lower-labral work.
  • Using modifier 59 to unbundle 29806 and 29807 on the same shoulder — NCCI Chapter 4 identifies the shoulder as a single anatomic structure and this is a documented audit trigger.
  • Coding a bony Bankart (glenoid rim fracture) from the S42.2- proximal humerus family instead of the correct S42.14- glenoid cavity of scapula family.
  • Reporting 23455 in addition to 23466, which already includes its work under AAOS global service data.
  • Relying on cached NCCI tables; PTP edits and modifier indicators are republished quarterly.
  • Reporting an open capsulorrhaphy code alongside 29806 for the same shoulder (bundled per AAOS guidance).
  • Reporting manipulation (23700) or dislocation treatment (23650–23660) separately with 29806.
  • Requesting a bone-block or coracoid transfer without CT quantification of glenoid bone loss.
  • Assuming remplissage is included in the Bankart repair code without checking payer position.
  • Selecting an open code (23455) when the operative note documents an entirely arthroscopic approach, or the reverse.
  • Failing to distinguish bony from soft-tissue Bankart in the operative note.
  • Using a non-specific diagnosis code instead of the laterality-specific S43.431A / S43.432A for SLAP.
  • Using the non-existent "M75.6-" degenerative labral code circulated by non-authoritative sources.
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Pearls and Pitfalls

PearlsPitfalls
Classify SLAP vs. Bankart before anything else.Treating "labral tear" as a single coding decision.
Capture instability history as structured fields.Narrative histories that omit recurrence count.
Quantify bone loss on CT before bone-procedure requests.Narrative impressions of "significant bone loss."
Anticipate the age-40 inflection for SLAP.Appealing an evidence-based tenodesis preference.
Flag remplissage pre-service.Discovering non-coverage after an intra-operative decision.
Know AAOS bundling for 29806 and 29807.Reporting bundled open or manipulation codes separately.
27

Frequently Asked Questions

Q1. What code reports an arthroscopic Bankart repair? 29806 (Arthroscopy, shoulder, surgical; capsulorrhaphy). Surgeons often document "recurrent instability" or "Bankart repair" rather than "capsulorrhaphy," but 29806 is the correct code.

Q2. What code reports a SLAP repair? 29807 (Arthroscopy, shoulder, surgical; repair of SLAP lesion), for repair of the superior labrum at the biceps anchor.

Q3. Can 29806 and 29807 be reported together? Authorities conflict. NCCI bundles the pair and permits only one per shoulder per session, treating the shoulder as a single anatomic structure under Chapter 4 and instructing that a modifier not be used to unbundle them; for Medicare and federally funded programs the combination will be denied. AAOS global service data takes the opposite position. Practically, where both halves of the labrum are repaired, the AAOS Bulletin advises appending modifier 22 to the single reported code. Confirm your payer's position in writing before adopting a two-code practice.

Q4. What does 29806 already include? Per AAOS bundling guidance: the open capsulorrhaphy codes 23450, 23455, 23460, 23462, and 23465; dislocation treatment codes 23650, 23655, and 23660; manipulation 23700; and thermal capsular shrinkage. It also includes 29805, 29820, 29822, and 29825.

Q5. Is there a code for open SLAP repair? No. There is no CPT code for open repair of a SLAP lesion, which is why 29807's bundling does not include an open counterpart.

Q6. How is the Latarjet procedure coded? The open coracoid transfer is 23462 (Capsulorrhaphy, anterior, any type; with coracoid process transfer). The arthroscopic version has no dedicated code and is generally reported as 29999 with an operative report and comparison code.

Q7. How is remplissage coded? There is no Category I code. Published guidance supports 29806 with modifier 22, or 29999. The AHA Coding Clinic for HCPCS (2016) suggested reporting 29999 in conjunction with 29806 when both labral repair and remplissage are performed. Payers commonly deny remplissage; verify pre-service.

Q8. What is the difference between 23460 and 23462? 23460 is anterior capsulorrhaphy with a bone block; 23462 is anterior capsulorrhaphy with coracoid process transfer. The graft source and technique distinguish them.

Q9. Which code applies to multidirectional instability? 23466 (Capsulorrhaphy, glenohumeral joint, any type multi-directional instability) for the open procedure. Multidirectional instability typically requires a documented extended rehabilitation trial before authorization.

Q10. Which code applies to posterior instability? 23465 (Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block) for the open procedure; arthroscopic posterior stabilization is reported as 29806.

Q11. Is a conservative-care trial required for recurrent instability? Generally not to the same degree as for degenerative conditions. Established recurrent traumatic instability with a structural lesion is typically supported by the recurrence history itself. Document episodes rather than manufacturing a retrospective trial.

Q12. What about a first-time dislocator? Policy is shifting. TurningPoint's 2026 MSK updates added first-time dislocation in an individual under age 30 to the exclusions from required non-operative treatment for capsulorrhaphy and Bankart procedures. Verify the specific plan's current language.

Q13. Why is age 40 significant for SLAP repair? Evidence indicates higher failure, stiffness, and reoperation rates after isolated SLAP repair in patients over 40, and systematic reviews support biceps tenodesis or tenotomy as reliable alternatives. Payers apply this evidence.

Q14. What imaging is expected? MR arthrography is preferred for labral pathology. CT or CT arthrography is expected when a bone-block or coracoid transfer is requested, to quantify glenoid bone loss.

Q15. What is on-track versus off-track? An assessment of whether a Hill-Sachs lesion engages the anterior glenoid rim. An off-track (engaging) lesion supports adding remplissage or a bone procedure, and documenting it is the clinical justification reviewers look for.

Q16. Which ICD-10 code supports a SLAP repair? S43.431A (right) or S43.432A (left), superior glenoid labrum lesion, initial encounter, with 7th character A/D/S.

Q17. Which ICD-10 code supports an instability repair? M24.411 (right) or M24.412 (left), recurrent dislocation of shoulder, is the primary instability code. Direction-specific subluxation and dislocation codes come from the S43.0- family with laterality and a 7th character.

Q18. How should a bony Bankart be documented? Distinguish it explicitly from a soft-tissue Bankart. A bony lesion may warrant an additional fracture code and affects both the coding approach and implant reporting.

Q19. Does traditional Medicare require prior authorization? No. There is no NCD or dedicated LCD, and labral repair is not in the OPD prior-authorization program. Medicare Advantage plans generally do require prior authorization.

Q20. Which vendors manage this code family? eviCore (CMM-315), Carelon (Joint Surgery), Cohere, Evolent/NIA (CG-318), TurningPoint, and HealthHelp on certain Blue Cross Blue Shield plans. Delegation varies widely; verify per plan.

Q21. What are the most common avoidable denials? Wrong labral code for the lesion location, missing instability history, bone procedures without CT quantification, and unflagged remplissage.

Q22. Where does detailed reimbursement analysis belong? Fee schedules, payment rates, NCCI/MUE tables, and revenue-cycle modeling belong in the GoHealthcare Revenue Cycle Knowledge Center, not in this operational guide.

28

Key Takeaways

  • SLAP and Bankart are two different problems sharing one anatomic structure — and two different codes (29807 vs. 29806).
  • 29806 is the arthroscopic Bankart code, even when the note never says "capsulorrhaphy."
  • Instability history — age at first dislocation, recurrence count, direction, bone loss — is the medical necessity.
  • Glenoid bone loss must be quantified on CT for any bone-block or coracoid transfer request.
  • Remplissage and arthroscopic coracoid transfer have no Category I code and require pre-service verification.
  • Age 40 is a real inflection point for isolated SLAP repair; expect payers to prefer biceps tenodesis.
  • AAOS bundling folds the open capsulorrhaphy family, dislocation treatment, and manipulation into 29806.
29

Future Outlook

  • Policy is moving toward earlier stabilization in young first-time dislocators, reflected in 2026 TurningPoint criteria changes; expect other vendors to follow.
  • Glenoid track and quantified bone-loss thresholds will become more explicit in criteria sets, increasing the operational importance of CT quantification.
  • Continued specialty-society pressure is likely toward Category I codes for remplissage and arthroscopic coracoid transfer, which remain unlisted.
  • Evidence continues to consolidate against isolated SLAP repair in older patients, which will further narrow coverage in that population.
  • Arthroscopic bone-augmentation techniques are expanding faster than the code set, sustaining unlisted-code burden and manual review.
  • Intelligent intake will increasingly auto-approve well-documented recurrent-instability cases, concentrating human review on bone loss and unlisted adjuncts.
30

References

  • American Medical Association. Current Procedural Terminology (CPT®) and CPT® Assistant. Website: https://www.ama-assn.org
  • American Academy of Orthopaedic Surgeons (AAOS). Bundling guidelines for shoulder arthroscopy codes 29806, 29807, and 29824; clinical practice guidance. Website: https://www.aaos.org
  • American Board of Orthopaedic Surgery (ABOS). Sports Medicine acceptable CPT® code listing. Website: https://www.abos.org
  • Centers for Medicare & Medicaid Services (CMS). Medicare Coverage Database (NCDs, LCDs, Articles). Website: https://www.cms.gov/medicare-coverage-database
  • eviCore by Evernorth. Comprehensive Musculoskeletal Management Guideline CMM-315 (Shoulder Surgery — Arthroscopic and Open Procedures) and MSK Joint CPT® code lists. Website: https://www.evicore.com
  • Carelon Medical Benefits Management. Joint Surgery Clinical Guideline and Musculoskeletal Program CPT® Codes and Descriptions. Website: https://guidelines.carelonmedicalbenefitsmanagement.com
  • Evolent / National Imaging Associates. Shoulder Arthroscopy Clinical Guideline (NIA_CG_318), Shoulder Labral Repair code group. Website: https://www.evolent.com
  • TurningPoint Healthcare Solutions. Musculoskeletal Medical Policies and 2026 Updates. Website: https://www.myturningpoint-healthcare.com
  • Arthroscopy Association of North America (AANA). Practice management and coding resources. Website: https://www.aana.org
  • American Shoulder and Elbow Surgeons (ASES). Coding and Reimbursement guidance. Website: https://ases-assn.org/about-ases/coding-reimbursement/
  • Erickson J, Lavery K, Monica J, Gatt C, Dhawan A. Surgical treatment of symptomatic superior labrum anterior-posterior tears in patients older than 40 years: a systematic review. Am J Sports Med. 2015;43(5):1274–1282. Website: https://journals.sagepub.com/home/ajs
  • Belk JW, Wharton BR, Houck DA, et al. Shoulder Stabilization Versus Immobilization for First-Time Anterior Shoulder Dislocation: A Systematic Review and Meta-analysis of Level 1 Randomized Controlled Trials. Am J Sports Med. 2023;51(6):1634–1643. Website: https://doi.org/10.1177/03635465211065403
  • Arciero RA, Wheeler JH, Ryan JB, et al. Arthroscopic Bankart Repair versus Nonoperative Treatment for Acute, Initial Anterior Shoulder Dislocations. Am J Sports Med. 1994;22(5):589–594. Website: https://journals.sagepub.com/home/ajs
  • Journal of the Pediatric Orthopaedic Society of North America (JPOSNA). Coding Challenges in Common Pediatric Sports Surgeries of the Shoulder, Elbow, and Ankle. Website: https://www.jposna.org
  • U.S. National Center for Health Statistics / CMS. ICD-10-CM (FY2026) Official Code Set. Website: https://www.cms.gov/medicare/coding-billing/icd-10-codes
31

Reading Recommendations

  • AAOS bundling guidance for shoulder arthroscopy codes 29806, 29807, and 29824.
  • Current eviCore CMM-315 and Carelon Joint Surgery guideline documents (verify version and effective date).
  • Evolent/NIA CG-318 Shoulder Labral Repair code group and UM matrix.
  • Systematic reviews on SLAP repair versus biceps tenodesis in patients over 40.
  • Literature on glenoid track, on-track/off-track assessment, and critical glenoid bone loss thresholds.
32

Related GoHealthcare Resources (Internal Links)

  • GoHealthcare MSK Specialty Procedure Library™ — Shoulder Arthroscopy (companion guide).
  • GoHealthcare MSK Specialty Procedure Library™ — Rotator Cuff Repair (companion guide).
  • GoHealthcare MSK Specialty Procedure Library™ — Shoulder Replacement and Reverse Shoulder Arthroplasty (companion guides).
  • GoHealthcare Revenue Cycle Knowledge Center — reimbursement methodology, NCCI/MUE, fee-schedule detail.
  • GoHealthcare Prior Authorization Playbooks and payer-policy watch. Website: https://www.gohealthcarellc.com
33

Recommended Downloads

  • Shoulder Instability History Intake Form (age at first dislocation, recurrence count, direction, bone loss).
  • SLAP versus Bankart Authorization Pathway Checklist.
  • Glenoid Bone Loss Documentation Worksheet (CT quantification and glenoid track).
  • Unlisted-Code Submission Packet Template (remplissage / arthroscopic coracoid transfer).
34

Visual Recommendations

  • Glenoid labrum clock-face diagram distinguishing SLAP from Bankart lesion locations.
  • Decision tree: SLAP versus Bankart versus multidirectional authorization pathway.
  • Glenoid bone loss and on-track/off-track assessment illustration.
  • CPT® selection map: arthroscopic vs. open, anterior vs. posterior vs. multidirectional.
  • AAOS bundling matrix showing what 29806 and 29807 already include.
35

Document History

VersionDateSummary
1.1July 2026Initial publication under GoHealthcare Clinical Procedure Guide Standard v1.0. Two-pass code audit applied at authoring, using the standing rule that official long descriptors are verified rather than summaries. Open capsulorrhaphy descriptors (23450, 23455, 23460, 23462, 23465, 23466) verified against ABOS, Carelon, and eviCore MSK Joint code lists including the list effective 02/01/2026. Remplissage and arthroscopic coracoid transfer confirmed to have no Category I code. ICD-10-CM verified against FY2026. Payer content reflects eviCore CMM-315, Carelon Joint Surgery, Evolent/NIA CG-318, TurningPoint 2026 updates, and HealthHelp PA listings. Independent second-pass audit corrections: bony Bankart fracture family corrected from S42.2- (upper end of humerus) to S42.14- (glenoid cavity of scapula); guidance on reporting 29806 with 29807 rewritten to reflect current NCCI Chapter 4 single-anatomic-structure bundling and the AAOS/NCCI conflict, replacing earlier guidance that modifier 59 applies; AAOS bundling list re-attributed to AAOS global service data with a quarterly-NCCI-verification note; AAOS position that remplissage is inclusive to the Bankart added alongside the AHA Coding Clinic position; AAOS guidance that 23466 includes the work of 23455 added.

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36

Educational Disclaimer

Educational Disclaimer

This document is part of the GoHealthcare Practice Solutions Knowledge Center and is intended for educational and operational reference purposes only. It is not a physician training or surgical technique manual and does not replace physician clinical judgment, payer policy review, legal advice, or official CMS guidance. It does not provide procedural technique, implant selection, medication dosing, or physician procedural training. Coverage policies, coding guidance, and reimbursement requirements change frequently and vary by payer and jurisdiction; always verify current CPT®, HCPCS, and ICD-10-CM codes and the applicable payer's current medical policy at the time of service. Procedures without Category I codes, including remplissage and arthroscopic coracoid transfer, require pre-service coverage verification. Developed by Pinky Maniri, MSc, CRCR, CSAPM, CSPPM, CSBI, CSPR, CSAF, Certified in Healthcare A.I. Governance, Founder and Chief Executive Officer of GoHealthcare Practice Solutions.

Developed by Pinky Maniri

Developed by Pinky Maniri, MSc
CRCR · CSAPM · CSPPM · CSBI · CSPR · CSAF
Certified in Healthcare A.I. Governance
Founder & Chief Executive Officer, GoHealthcare Practice Solutions
A Musculoskeletal Specialty Management Services Organization (MSO)
Prior Authorization · Medical Necessity · Payer Intelligence · Revenue Cycle · Operations

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