What documentation does Aetna require for CPT 29827?

Shoulder MRI showing tear; PT records (6+ weeks); Documentation of injection trial; Clinical exam findings

How much does Medicare pay for CPT 29827 in 2026?

In 2026, the national Medicare allowable for CPT 29827 is $976.31 in an office setting and $976.31 in a facility. Commercial allowables for Aetna are typically negotiated against this benchmark.

What if Aetna denies the PA for CPT 29827?

Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

Prior Authorization

Aetna Prior Authorization for CPT 29827

Arthroscopy procedures with site of service review (except in certain states) · Standard commercial plans

Prior authorization REQUIREDApplies to all statesLast verified January 1, 2026 · Reviewed by the D3rx Clinical Billing Team

Source

Aetna Participating Provider Precertification List 2026 (Updated May 1, 2026)

Not medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.

Clinical criteria

Aetna requires precertification for arthroscopic rotator cuff repair. Covered for MRI-confirmed full-thickness tear or symptomatic partial-thickness tear (>50%) after 6+ weeks of conservative treatment. Acute traumatic tears may bypass conservative therapy requirement. Patch augmentation and xenograft products are experimental.

Documentation checklist

✓Shoulder MRI showing tear
✓PT records (6+ weeks)
✓Documentation of injection trial
✓Clinical exam findings

Submission channels

Phone

1-800-624-0756

Fax

1-860-754-5670

2026 Medicare rate for CPT 29827

Office (non-facility)

$976.31

Facility

$976.31

Total RVUs (office)

29.23

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Aetna's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 29827 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather documentation: Shoulder MRI showing tear, PT records (6+ weeks), Documentation of injection trial….
3Submit via phone or fax, or the payer portal.
4Document the reference number and follow up within 5 business days if no determination is received.

FAQ

Does Aetna require prior authorization for CPT 29827?: Yes. Aetna requires prior authorization for CPT 29827 (Arthroscopy procedures with site of service review (except in certain states)) under Standard commercial plans per its published clinical policy.
What documentation does Aetna require for CPT 29827?: Shoulder MRI showing tear; PT records (6+ weeks); Documentation of injection trial; Clinical exam findings
How much does Medicare pay for CPT 29827 in 2026?: In 2026, the national Medicare allowable for CPT 29827 is $976.31 in an office setting and $976.31 in a facility. Commercial allowables for Aetna are typically negotiated against this benchmark.
What if Aetna denies the PA for CPT 29827?: Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.

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CPT 29827 prior authorization by payer

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