procedure code 23472 — prior authorization under Medicaid
Billing code 23472 · Category: surgical
In our reference, this procedure typically requires prior authorization.
Typical turnaround is 10 day(s); Medicaid's
standard turnaround is 14 calendar days (3 business days if urgent).
How to submit
State Medicaid portal, MCO portal if managed care
Documentation typically required
Shoulder X-ray/MRI
PT records
Functional limitation assessment
Common reasons this gets denied
Conservative therapy not exhausted
Insufficient imaging
Medicaid-specific notes
PA requirements vary by state and MCO
EPSDT may bypass PA for children
Retroactive PA possible within state-defined windows
Emergency services cannot require PA under federal law
Coverage limits: this page does not confirm authorization for any specific member's plan, and does not cover state-specific plan variants, out-of-network requests, or every payer x procedure pair in existence. For a definitive answer, contact Medicaid directly using the submission method above.
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