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PAYER POLICY CHANGES

11042 Insurance Policy Changes

CPT 11042, in plain terms, covers Clinician debrides subcutaneous tissue, including skin if needed, for the first 20 square centimeters or less. CPT 11042 is referenced in 5 tracked payer policy changes from Independence Blue Cross, Regence BlueShield, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 11042 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 11042 on AAPC

Watch 11042

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REFERENCE DATA

Payers with rules6
Payers requiring prior auth6
  • Anthem BCBS · Effective October 19, 2026

    Prior authorization required

    Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial)

  • Arizona Complete Health · Effective December 31, 2025

    Prior authorization required

    Arizona Complete Health CMS-0057-F prior authorization requirements

  • 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 11042?

Anthem BCBS lists 11042 on Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial) for commercial plans (list dated October 19, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 11042?

Arizona Complete Health lists 11042 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 11042?

CalViva Health lists 11042 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 Centene require prior authorization for 11042?

Centene lists 11042 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance 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 11042?

Community Health Plan of Imperial Valley lists 11042 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 11042?

There are 5 tracked policy changes affecting CPT 11042, including updates from Independence Blue Cross, Regence BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 11042?

Payers that have issued tracked updates for CPT 11042 include: Independence Blue Cross, Regence BlueShield, Aetna.

How do I get notified when CPT 11042 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 11042. 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 11042?

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 11042

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 11042 in one place.

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