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PAYER POLICY CHANGES

00811 Insurance Policy Changes

CPT 00811 is referenced in 2 tracked payer policy changes from Medicare/CMS - Transmittals and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 00811 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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REFERENCE DATA

Payers with rules4
Payers requiring prior auth4
  • Anthem BCBS · Effective November 1, 2026

    Prior authorization required

    Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)

  • Blue Shield of California · Effective October 1, 2026

    Prior authorization required

    Prior Authorization List for Blue Shield of California

  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Anthem BCBS require prior authorization for 00811?

Anthem BCBS lists 00811 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Blue Shield of California require prior authorization for 00811?

Blue Shield of California lists 00811 on Prior Authorization List for Blue Shield of California for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 00811?

CalViva Health lists 00811 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 00811?

Community Health Plan of Imperial Valley lists 00811 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 00811?

There are 2 tracked policy changes affecting CPT 00811, including updates from Medicare/CMS - Transmittals, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 00811?

Payers that have issued tracked updates for CPT 00811 include: Medicare/CMS - Transmittals, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 00811 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 00811. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for CPT 00811?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for 00811

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 00811 in one place.

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