CPT 23472 · Arthroplasty — Shoulder · New Jersey PIP
Total Shoulder Arthroplasty (TSA / Reverse TSA) at New Jersey PIP.
How New Jersey PIP 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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NJ-PIP-2026Criteria summary
High-level themes from the New Jersey PIP 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: NJ PIP Care Path / Medical-Necessity per N.J.A.C. 11:3-4 (Personal Injury Protection)
See the full New Jersey PIP criteria.
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