United Healthcare Policy Updates

Mar 18

United Healthcare Policy Updates for Arthroscopic Shoulder Procedures and Manipulation Under Anesthesia

United Healthcare (UHC) updated two policies effective February 1, 2025, which have significant implications for arthroscopic shoulder procedures and manipulation under anesthesia.

First, United Healthcare’s policy for arthroscopic shoulder procedures guidelines correspond with NCCI guidelines. CPT 29823 Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies]) will only be considered for separate reimbursement when submitted in addition to the following codes and when the extensive debridement is performed in different areas of the same shoulder. Modifier 59 Distinct procedural service is not allowed to override the bundling edit.

29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)
29827 Arthroscopy, shoulder, surgical; with rotator cuff repair
29828 Arthroscopy, shoulder, surgical; biceps tenodesis

Second, manipulation under anesthesia is only considered medically necessary in the shoulder joint for adhesive capsulitis and knee for arthrofibrosis following a total knee arthroplasty, knee surgery, or fracture, provided certain criteria are met. UHC considers manipulation under anesthesia not medically necessary or unproven for all other conditions on the ankle, finger, hip, pelvis, spine, temporomandibular joint, toe, and wrist.

This policy does not apply to the treatment of Dupuytren’s contracture, elbow joint for arthrofibrosis following elbow surgery or fracture, or closed reduction of a fracture or dislocation unless specified.

Lastly, on April 1, 2025, UHC will update its policies on certain orthopaedic procedures, devices, and products.

Computer-Assisted Surgical Navigation for Musculoskeletal Procedures
- Are considered experimental and incidental to the primary procedure and not separately reimbursed. CPT/HCPCS codes affected (0054T, 0055T, 20985)
Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions and Soft Tissue Wounds
- Is considered experimental but will recognize Local Coverage Determinations (LCDs) for Kentucky, Louisiana, New Jersey, New Mexico, Ohio, Pennsylvania, and Tennessee.
Kinesio Taping
- Considered not medically necessary and unproven. CPT/HCPCS codes affected (29799, 97139, 97799, A9999 when used for Kinesio taping).
Unicondylar Spacer Devices for Treatment of Pain or Disability
- Considered not medically necessary and unproven. CPT/HCPCS codes affected (27599).

Contact us with any questions or for assistance with implementing these policies in your practice.