What insurance policy changes affect CPT 19325?

There are 11 tracked policy changes affecting CPT 19325, 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 19325 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 19325. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 19325?

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.

19325 — A surgical procedure to enlarge the breast using an implant placed beneath the breast tissue or muscle.: Insurance Policy Changes

Q: Which payers have updated policy for CPT 19325?

Payers that have issued tracked updates for CPT 19325 include: Arkansas Blue Cross Blue Shield, Blue Cross Blue Shield of Rhode Island, Excellus BlueCross BlueShield, Humana, Blue Cross & Blue Shield of Mississippi.

19325 Insurance Policy Changes

CPT 19325, in plain terms, covers A surgical procedure to enlarge the breast using an implant placed beneath the breast tissue or muscle. CPT 19325 is referenced in 11 tracked payer policy changes from Arkansas Blue Cross Blue Shield, Blue Cross Blue Shield of Rhode Island, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 19325 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.

19325 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)

Breast Reconstruction Following Mastectomy

Augmentation Mammoplasty