Shoulder Arthroplasty - Medicare Advantage

This policy covers shoulder arthroplasty procedures—including total (anatomic) shoulder arthroplasty (TSA), reverse TSA (rTSA), hemiarthroplasty, resurfacing, and revision arthroplasty—for treatment of glenohumeral joint conditions such as osteoarthritis, avascular necrosis, inflammatory/rheumatoid arthritis, massive rotator cuff tear arthropathy, and severe fractures. Coverage is subject to Medicare medical necessity and applicable CMS NCD/LCD/LCA and local MAC LCD requirements (including LCD L39956 where applicable), requires FDA‑approved implants for certain procedures, and excludes cases with contraindications like active/local infection, implant material allergy, deltoid deficiency, inadequate bone stock, neuropathic arthropathy, or paralytic disorders.

"Report for soft tissue pathology (e."

Sign up to see full coverage criteria, indications, and limitations.