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PAYER POLICY CHANGES

11960 Insurance Policy Changes

CPT 11960, in plain terms, covers Clinician inserts one or more tissue expanders at a site other than the breast, including the later expansion sessions. CPT 11960 is referenced in 1 tracked payer policy change from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 11960 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 11960 on AAPC

Watch 11960

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REFERENCE DATA

Payers with rules13
Payers requiring prior auth13
  • Blue Shield of California · Effective November 1, 2026

    Prior authorization required

    Prior Authorization List for Blue Shield Medicare

  • Fidelis Care · Effective November 1, 2026

    Prior authorization required in some cases

    Fidelis Care Metal-Level Products authorization grid

  • BCBS Michigan · Effective October 13, 2026

    Prior authorization required in some cases

    BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

FREQUENTLY ASKED QUESTIONS

Does AmeriHealth Caritas require prior authorization for 11960?

AmeriHealth Caritas lists 11960 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 11960?

Arizona Complete Health lists 11960 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 BCBS Illinois require prior authorization for 11960?

BCBS Illinois lists 11960 on Blue Cross Community Health Plans (Illinois Medicaid) Prior Authorization Code List for medicaid managed plans, with conditions (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for 11960?

BCBS Michigan lists 11960 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

Does BCBS New Mexico require prior authorization for 11960?

BCBS New Mexico lists 11960 on BCBSNM Turquoise Care (New Mexico Medicaid) Preauthorization Procedure Code List for medicaid managed plans, with conditions (list dated October 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 11960?

There are 1 tracked policy change affecting CPT 11960, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 11960?

Payers that have issued tracked updates for CPT 11960 include: Aetna.

How do I get notified when CPT 11960 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 11960. 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 11960?

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 11960

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 11960 in one place.

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