CurrentCareFirstPolicy 7.01.115

Shoulder Resurfacing Arthroplasty

Defines CareFirst coverage position for shoulder resurfacing arthroplasty (humeral head resurfacing with/without glenoid resurfacing) including definition of experimental/investigational status, rationale, literature updates, reporting guidance, and benefit applicability.

Policy Summary

PayerCareFirst

PolicyShoulder Resurfacing Arthroplasty

Policy CodePolicy 7.01.115

Change TypeClarified (literature update)

Effective DateDec 1, 2025

Next Review Date

Key ActionReport shoulder resurfacing arthroplasty using the CPT Category I unlisted shoulder procedure code as instructed in Provider Guidelines.

POLICY UPDATE CHANGES

Update 2025 literature search found no change to policy conclusions; policy remains experimental/investigational.

1Coverage stance (not covered experimental)

MultipleLiterature update years reviewed

Coverage Summary

CareFirst Policy 7.01.115 (effective 2025-12-01) states that shoulder resurfacing arthroplasty is considered experimental/investigational and is not covered. The policy number is 7.01.115. Scope: defines CareFirst's coverage position for humeral head resurfacing (with or without glenoid resurfacing), provides the rationale for experimental/investigational status, summarizes literature updates, and gives reporting and benefit applicability guidance.

Key facts

Policy number7.01.115

Effective date12/01/2025

Last review09/10/2025

Coverage stanceNot covered — experimental/investigational

Scope summaryDefines CareFirst coverage position for humeral head resurfacing (with/without glenoid resurfacing): considered experimental/investigational, rationale, literature updates, reporting guidance, and benefit applicability.