What insurance policy changes affect CPT 19316?

There are 9 tracked policy changes affecting CPT 19316, including updates from Arkansas Blue Cross Blue Shield, Blue Cross Blue Shield of Rhode Island, Excellus BlueCross BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

How do I get notified when CPT 19316 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 19316. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 19316?

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.

19316 — A surgical procedure to lift and reshape sagging breast tissue to restore a more youthful appearance.: Insurance Policy Changes

Q: Which payers have updated policy for CPT 19316?

Payers that have issued tracked updates for CPT 19316 include: Arkansas Blue Cross Blue Shield, Blue Cross Blue Shield of Rhode Island, Excellus BlueCross BlueShield, Humana.

19316 Insurance Policy Changes

CPT 19316, in plain terms, covers A surgical procedure to lift and reshape sagging breast tissue to restore a more youthful appearance. CPT 19316 is referenced in 9 tracked payer policy changes from Arkansas Blue Cross Blue Shield, Blue Cross Blue Shield of Rhode Island, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 19316 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 7.01.11

Excellus BlueCross BlueShield·Effective Sep 18, 2025

Excellus BlueCross BlueShield updated their cosmetic and reconstructive procedures policy effective September 18, 2025, establishing new detailed criteria for determining when procedures are considered reconstructive (covered) versus cosmetic (not covered). The policy provides specific functional deficit requirements and indication-specific criteria for numerous procedures including breast procedures, chest wall deformity corrections, hyperhidrosis treatments, and various skin procedures.

19316 Insurance Policy Changes

Payment Policy Material Amendment

Medical policy updates

Cosmetic and Reconstructive Procedures 7.01.11

Breast Procedures - MEDICAID - KENTUCKY (Revised)

Breast Surgery - MEDICAID - LOUISIANA (Revised)

Breast Procedures - MEDICAID - OKLAHOMA (Revised)

Breast Procedures - MEDICAID - FLORIDA (Revised)

Breast Procedures - MEDICAID - VIRGINIA (Revised)

Breast Procedures - MEDICAID - SOUTH CAROLINA (Revised)