CPT 23472 · Arthroplasty — Shoulder · Humana Medicare Advantage
Total Shoulder Arthroplasty (TSA / Reverse TSA) at Humana Medicare Advantage.
How Humana Medicare Advantage approaches CPT 23472 (Total Shoulder Arthroplasty (TSA / Reverse TSA)) for prior-authorization review: at last review on 2026-05-02, the policy covers this code with prior authorization required.
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Humana-MA-23472-2026Criteria summary
High-level themes from the Humana Medicare Advantage 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: Humana Medical Coverage Policy — Surgical Procedures (MA)
See the full Humana Medicare Advantage criteria.
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