Shoulder Arthroscopy — Aetna

Score

97.8

Pass · 2m 15s

Criteria

Identified rotator cuff tear from imaging1.0

Documented failed conservative treatment1.0

Correct procedure code selected0.9

Authorization obtained1.0

Patient

Michael Torres, 52M

Primary Dx

M75.110 — Rotator cuff tear

Payer

Aetna HMO

Procedure

CPT 29827 — Arthroscopy

Tear Size

2.5cm retraction

BMI

26.8

Changes made by agent

Auth StatusNone→Approved (AET-2026-2204819)

Auth Expiry—→2026-06-25 (60 days)

Agent Activity

0:00

Read patient chart

Accessed patient record, MRI findings, orthopedic consult notes.

0:10

Reviewed MRI findings

Full-thickness supraspinatus tear with 2.5cm retraction confirmed by MRI.

0:25

Checked payer requirements

Queried Aetna for arthroscopic rotator cuff repair criteria.

1:10

Compiled documentation

MRI report, orthopedic consult, failed conservative treatment (NSAIDs, activity modification).

1:40

Submitted to payer

Submitted via Aetna portal with surgical recommendation and supporting evidence.

2:15

Authorization received

Auth #AET-2026-2204819 approved. Updated patient record.