Surgery of the Shoulder – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers shoulder surgeries (arthroscopy/arthroscopically assisted procedures, diagnostic arthroscopy, joint replacement and revisions) when members meet clinical medical‑necessity criteria, but considers subacromial balloon/biodegradable spacers unproven and not medically necessary. Coverage requires documentation that the member meets InterQual® CP criteria and any member‑specific benefit plan terms (e.g., imaging, exam findings, prior conservative therapy, operative notes), and the member’s plan language governs if conflicts arise.

"InterQual® CP: Procedures - Arthroscopy or Arthroscopically Assisted Surgery, Shoulder (Adolescent) (used as the medical necessity clinical coverage criteria)."

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