Does Medicare now require a doctor or PA evaluation for shoulder surgery, and what is the timeframe?

Answered by 2 licensed agents

This is completely dependent on the type of plan you have. You can call the number on the back of your card and ask.

Answered by Shari Kantor on August 5, 2026

Broker Licensed in NJ, DE, FL, PA, TX & WV

Answered by Shari Kantor Medicare Insurance Agent
, but it does not mandate a rigid nationwide prior authorization evaluation for routine shoulder operations. However, if you have a Medicare Advantage plan or live in a state testing specific prior authorization models, rules and approval timeframes (typically 7 calendar days for standard requests or 72 hours for urgent ones) vary.

Answered by Melanie Blackston on August 5, 2026

Broker Licensed in SC, GA & NC

Answered by Melanie Blackston Medicare Insurance Agent

Tags: Advice for Seniors Coverage The Medicare System

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