CPT 23472 · Other Procedure · BCBS New Mexico
Total Shoulder Arthroplasty (TSA / Reverse TSA) at BCBS New Mexico.
How BCBS New Mexico approaches CPT 23472 (Total Shoulder Arthroplasty (TSA / Reverse TSA)) for prior-authorization review: at last review on 2026-01-01, the policy covers this code with prior authorization required.
Free with practitioner sign-in — magic-link email auth, no credit card.
Carelon Joint Surgery 2025-11-15Criteria summary
High-level themes from the BCBS New Mexico policy of record for CPT 23472. Verbatim policy text and per-criterion analysis are available after sign-in.
- At least 12 weeks of conservative care typically required.
- Imaging concordance documentation required.
Source: Carelon Clinical Appropriateness Guidelines — Joint Surgery / Shoulder Arthroplasty
See the full BCBS New Mexico criteria.
Sign in for verbatim conservative-care language, exact imaging-concordance rules, repeat-procedure thresholds, and the denial-risk score for any specific clinical scenario.
Sign in — free for practitioners →