Total Shoulder Arthroplasty

Total shoulder arthroplasty (including aTSA and RTSA) is covered for degenerative glenohumeral disease, certain proximal humerus fractures, nonunion/malunion, reconstruction after tumor resection, massive irreparable rotator cuff tears with objective imaging and clinical criteria, and RTSA after failed prior arthroplasty. Coverage requires radiographic/imaging evidence, ≥12 weeks of documented moderate-to-severe pain or disability and ≥12 weeks of unsuccessful conservative therapy (including 12 weeks supervised PT for MIRCTs) or a documented reason why conservative therapy is inappropriate, and procedures must be performed by appropriately credentialed providers.

"Total shoulder arthroplasty (TSA) is indicated for degenerative glenohumeral joint disease (including osteoarthritis, post-traumatic arthritis, rheumatoid arthritis, osteonecrosis, or arthropathy w..."