Does C9781 require prior authorization?

No, C9781 does not require prior authorization (high confidence). Code is covered without prior authorization.

`C9781`, Arthroscopy, shoulder, surgical; with implantation of subacromial spacer (e.g.,

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Documentation supporting medical necessity and a clearly stated plan of care must be submitted at the time of the request and must include the components described, including clinical notes detailing symptom duration/severity, functional limitations, and the type/duration of all therapeutic measures provided; if conservative management is not appropriate, the reason must be documented.
Documentation: Documentation supporting medical necessity and a clearly stated plan of care must be provided at the time of the request.
Documentation: Conservative management must include a combination of strategies (including physical therapy) and at least one complementary conservative treatment.

Indication: Proximal humerus fracture not amenable to internal fixation.
Indication: Advanced shoulder joint disease due to OA/RA/AVN/post-traumatic arthritis when ALL the following requirements are met.
The use of subacromial balloon spacers for any indication, including but not limited to rotator cuff repairs, is considered investigational.
Therefore, the use of subacromial balloons for rotator cuff repairs is considered investigational.

REGENCE-SUR226, Subacromial Balloon Placement

CARELON-joint-surgery-2024-11-17-updated-2025-01-01, Joint Surgery

CARELON-joint-surgery-2025-11-15, Joint Surgery