What documentation does Humana require for CPT 29827?

Shoulder MRI with tear measurement; PT records (6+ weeks); Injection documentation; Orthopedic evaluation

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 Humana are typically negotiated against this benchmark.

What if Humana 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

Humana 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

Humana Commercial Preauthorization and Notification List (July 2024)

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

Humana requires prior authorization for arthroscopic rotator cuff repair. Must document imaging-confirmed tear, failed conservative management for 6+ weeks including PT and at least one corticosteroid injection, and persistent functional limitation. Massive tears in elderly patients may require additional documentation of expected functional benefit.

Documentation checklist

✓Shoulder MRI with tear measurement
✓PT records (6+ weeks)
✓Injection documentation
✓Orthopedic evaluation

Submission channels

Phone

1-800-444-9137

Fax

1-877-418-0506

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). Humana'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 with tear measurement, PT records (6+ weeks), Injection documentation….
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 Humana require prior authorization for CPT 29827?: Yes. Humana 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 Humana require for CPT 29827?: Shoulder MRI with tear measurement; PT records (6+ weeks); Injection documentation; Orthopedic evaluation
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 Humana are typically negotiated against this benchmark.
What if Humana 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.

Other Humana PA lookups

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CPT 29827 prior authorization by payer

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