What insurance policy changes affect CPT 11901?

There are 8 tracked policy changes affecting CPT 11901, including updates from Blue Shield of California, CareFirst BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 11901?

Payers that have issued tracked updates for CPT 11901 include: Blue Shield of California, CareFirst BlueCross BlueShield, Aetna, Health Net, Excellus BlueCross BlueShield.

How do I get notified when CPT 11901 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 11901. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 11901?

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.

11901 — A doctor injects medication directly into multiple skin growths larger than seven millimeters to treat them.: Insurance Policy Changes

11901 Insurance Policy Changes

CPT 11901, in plain terms, covers A doctor injects medication directly into multiple skin growths larger than seven millimeters to treat them. CPT 11901 is referenced in 8 tracked payer policy changes from Blue Shield of California, CareFirst BlueCross BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 11901 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Cosmetic and Reconstructive Procedures (BSC7.08)

Blue Shield of California·Effective Sep 1, 2026

Blue Shield of California updated its Cosmetic and Reconstructive Procedures policy (BSC7.08) effective September 1, 2026. The policy clarifies coverage criteria for reconstructive procedures (requiring functional improvement or normalized appearance) versus cosmetic procedures (generally non-covered). Key changes include specific requirements for chest wall deformities (pectus excavatum requiring Haller index ≥3.25 plus functional impairment), expanded guidance on benign skin lesions, and explicit exclusion of certain procedures (breast augmentation, hair transplants, tattoo removal) unless they meet reconstructive criteria or treat medical conditions like HIV-related lipoatrophy.

11901 Insurance Policy Changes

Cosmetic and Reconstructive Procedures (BSC7.08)

Payment Policy Updates

Talimogene Laherparepvec (Imlygic) (CPB 0900, reviewed 2026-04-14)

25-997 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

25-998 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

Cosmetic and Reconstructive Procedures 7.01.11

Lymphangioma and Infantile Hemangioma (CPB 0817, reviewed 2025-12-03)

25-996 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency