Does Ambetter require prior authorization for 17999?

Ambetter lists 17999 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for 17999?

AmeriHealth Caritas lists 17999 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 17999?

Anthem BCBS lists 17999 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 Arizona Complete Health require prior authorization for 17999?

Arizona Complete Health lists 17999 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 17999?

BCBS Illinois lists 17999 on Utilization Management Process for medicare advantage plans (list dated October 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 17999?

There are 10 tracked policy changes affecting CPT 17999, including updates from UnitedHealthcare, Sentara Health Plans, Blue Shield of California. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 17999?

Payers that have issued tracked updates for CPT 17999 include: UnitedHealthcare, Sentara Health Plans, Blue Shield of California, Excellus BlueCross BlueShield, Regence BlueShield, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 17999 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 17999. 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 17999?

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.

PAYER POLICY CHANGES

17999 Insurance Policy Changes

CPT 17999 is referenced in 10 tracked payer policy changes from UnitedHealthcare, Sentara Health Plans, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 17999 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

UnitedHealthcare · Effective Jan 1, 2027High impact
Omnibus Codes
UMR revised its medical policy bulletin for November 2026, adding unproven/not medically necessary language for several services (including photobiomodulation for AMD, CRISPR-based TB plasma testing, Alzheimer's proprietary biomarker and genetic tests, and digital 3D models from surface mesh files) and revising criteria for IRE ablation, BeScreened-CRC, BIOTIA-ID, IVD CAPSULE PSP, histotripsy, external urine management systems, sacral Tarlov cyst surgery (now requiring failure of conservative multidisciplinary management instead of 12 weeks of non-surgical treatment), and meibomian gland procedures. The bulletin's status is revised with an effective date of 2027-01-01 for these coverage guidelines.
Sentara Health Plans · Effective Jan 1, 2027High impact
Authorization Updates - Effective January 1, 2027
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
Omnibus Codes
UnitedHealthcare's November 2026 Exchange bulletin, effective 2027-01-01, adds coverage language that several services (3D model creation from surface mesh files, CRISPR-based TB plasma/serum analysis, multianalyte Alzheimer/dementia lab tests, photobiomodulation for AMD, meibomian gland evaluation/evacuation incl. CPT 17999, histotripsy incl. CPT 1037T, and percutaneous gastrostomy with magnetic gastropexy) is unproven and not medically necessary, and revises criteria for irreversible electroporation, BeScreened-CRC, BIOTIA-ID, IVD CAPSULE PSP, external urine management systems (HCPCS E2001), noninvasive bimodal neuromodulation (E1399), and sacral Tarlov cyst surgery (63268, which now requires failure of conservative multidisciplinary management rather than 12 weeks of non-surgical treatment). Billing teams should hold these services for Exchange members as of 2027-01-01 and update charge entry and claim edits accordingly.
UnitedHealthcare · Effective Jan 1, 2027Medium impact
Omnibus Codes
Surest published its November 2026 medical policy bulletin revising coverage for a range of services; the new omnibus policy language is listed with an effective date of 2027-01-01. Several services are newly stated as unproven and not medically necessary, including digital 3D anatomical models (CPT 1030T-1035T), CRISPR-based TB plasma/serum analysis (0629U), Alzheimer's/dementia proprietary biomarker and genetic tests, photobiomodulation for AMD (0936T), and magnetic gastropexy gastrostomy (0647T), while coverage language was revised for IRE ablation, BeScreened-CRC, BIOTIA-ID, IVD CAPSULE PSP, histotripsy (now including pancreatic tumors, with new code 1037T), meibomian gland procedures (new code 17999), external urine management systems, and sacral Tarlov cyst surgery (criterion changed to conservative multidisciplinary management).
UnitedHealthcare · Effective Jan 1, 2027Medium impact
Omnibus Codes
UnitedHealthcare's November 2026 commercial medical policy bulletin revises coverage for the Omnibus Codes group, adding several services as unproven and not medically necessary (including digital 3D anatomical models, CRISPR-based TB plasma/serum analysis, multianalyte Alzheimer's/dementia laboratory tests, photobiomodulation for AMD, and CPT 17999 under meibomian gland evaluation) and revising criteria for IRE ablation, BeScreened-CRC, BIOTIA-ID, IVD CAPSULE PSP, histotripsy (now including pancreatic tumors), external urine management systems, Tarlov cyst surgery, and percutaneous gastrostomy with magnetic gastropexy. The billing team should stop scheduling and billing these services for commercial members and update charge entry and claim edits so they are not submitted as covered services, with the effective date of January 1, 2027 stated in the bulletin.
Blue Shield of California · Effective Nov 1, 2026Medium impact
Cosmetic and Reconstructive Procedures (BSC7.08)
Effective November 1, 2026, Blue Shield of California's Cosmetic and Reconstructive Procedures policy (BSC7.08) has an updated policy statement, guidelines, literature and coding. Reconstructive procedures may be considered medically necessary when the policy criteria are met, including surgery to correct or repair abnormal structures of the body caused by congenital defects, developmental abnormalities, trauma, infection, tumors, or disease. Procedures such as breast augmentation with implants (19325), breast lift (19316), dermabrasion (15780-15783), hair transplant (15775, 15776), tattooing and tattoo removal (11920-11922), and ear or body piercing (69090) are typically considered cosmetic and not medically necessary for all indications unless the policy says otherwise. A procedure may be denied as not medically necessary if it is likely to result in only minimal improvement in appearance, if the treating surgeon cannot or will not provide sufficient documentation, if there is an alternative approved intervention with equal or superior clinical outcomes, or if it is for cosmetic purposes only.
Excellus BlueCross BlueShield · Effective Sep 17, 2026Medium impact
Cosmetic and Reconstructive Procedures 7.01.11
Policy 7.01.11 treats reconstructive procedures as medically appropriate only when a functional deficit is documented, a reconstructive purpose is documented, and the indication-specific criteria are met, such as the criteria for acne surgery, benign skin lesion removal, breast procedures, pectus repair, dermabrasion, otoplasty, hypertrophic scar revision, and vulvectomy as part of cancer surgery. Procedures that reshape structures to improve appearance or self-esteem without a functional deficit, including breast augmentation with implants, breast lift, rhytidectomy, tattooing, chemical peels, hair transplant, hair removal, and non-surgical body sculpting, are considered cosmetic and not medically necessary for all indications unless the reconstructive criteria are met. Cryotherapy for acne, certain hyperhidrosis treatments, and autologous melanocyte transplantation for vitiligo are investigational.
Regence BlueShield · Effective Apr 1, 2026Medium impact
Gender Affirming Interventions for Gender Dysphoria
Gender affirming interventions for gender dysphoria may be considered medically necessary when the criteria for the member's contract type are met. For member contracts subject to Washington's Gender Affirming Treatment Act (SSB 5313) or Oregon Reproductive Health Rights (HB 2002), the criteria include a diagnosis of gender dysphoria by a licensed mental health professional, six continuous months of hormone therapy in the prior 12 months unless hormones are not clinically indicated, six months of living in a role congruent with the patient's identity, and either age 18 or older or documented medical necessity of earlier intervention for a non-genital request. For all other member contracts, the criteria include age of at least 18 years, the same diagnosis, hormone and living-role requirements, and either a listed surgical procedure such as vaginoplasty, orchiectomy or breast/chest surgery or a listed procedure such as hair removal or facial gender confirmation surgery when documentation shows it would improve significant gender dysphoria; reversal of gender affirming interventions and revisions made because of dissatisfaction with appearance are considered not medically necessary.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Microwave Tumor Ablation
This Blue Cross Blue Shield Association policy states that microwave ablation of primary or metastatic liver tumors may be considered medically necessary when the tumor is unresectable due to lesion location and/or comorbid conditions and is a single tumor of 5 cm or less or up to 3 nodules of 3 cm or less each. Microwave ablation of primary or metastatic lung tumors may be considered medically necessary when the tumor is unresectable due to lesion location and/or comorbid conditions and is a single tumor of 3 cm or less. Microwave ablation of more than a single lung tumor, and of primary or metastatic tumors other than liver or lung, is considered investigational.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Laser Treatment of Onychomycosis
Laser treatment of onychomycosis is considered investigational under this policy, and investigational services are not considered medically necessary. Multiple Nd:YAG laser systems have been cleared by the FDA for the temporary increase of clear nail in patients with onychomycosis. Federal Employee Program (FEP) may dictate that FDA-approved devices may not be considered investigational, so these devices may be assessed only on the basis of medical necessity. The policy was reviewed on 05/22/2026 with no changes.

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Omnibus Codes

Authorization Updates - Effective January 1, 2027

Omnibus Codes

Omnibus Codes

Omnibus Codes

Cosmetic and Reconstructive Procedures (BSC7.08)

Cosmetic and Reconstructive Procedures 7.01.11

Gender Affirming Interventions for Gender Dysphoria

Microwave Tumor Ablation

Laser Treatment of Onychomycosis

Prior authorization required

Prior authorization required in some cases

Prior authorization required in some cases

Does Ambetter require prior authorization for 17999?

Does AmeriHealth Caritas require prior authorization for 17999?

Does Anthem BCBS require prior authorization for 17999?

Does Arizona Complete Health require prior authorization for 17999?

Does BCBS Illinois require prior authorization for 17999?

What insurance policy changes affect CPT 17999?

Which payers have updated policy for CPT 17999?

How do I get notified when CPT 17999 policy changes?

Why do payers change policies for CPT 17999?