What insurance policy changes affect CPT 19396?

There are 10 tracked policy changes affecting CPT 19396, including updates from Arkansas Blue Cross Blue Shield, Aetna, Blue Cross Blue Shield of Rhode Island. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 19396?

Payers that have issued tracked updates for CPT 19396 include: Arkansas Blue Cross Blue Shield, Aetna, Blue Cross Blue Shield of Rhode Island, Humana, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 19396 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 19396. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 19396?

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.

19396 — A surgeon creates a personalized breast implant specifically tailored to match your body's unique measurements and appearance goals.: Insurance Policy Changes

19396 Insurance Policy Changes

CPT 19396, in plain terms, covers A surgeon creates a personalized breast implant specifically tailored to match your body's unique measurements and appearance goals. CPT 19396 is referenced in 10 tracked payer policy changes from Arkansas Blue Cross Blue Shield, Aetna, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 19396 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

OfficeLink Updates - April 2026 notices and reminders (PDF)

Aetna·Effective Jul 1, 2026

Aetna is implementing multiple policy changes effective July 1, 2026, including updates to pharmacy drug lists, Combined Benefit Management drug list changes that may move specialty drugs between medical and pharmacy benefits, and new billing restrictions for reconstructive surgery codes when performed with breast or digestive system surgeries. Remote Physiologic Monitoring coverage is now limited to heart failure, hypertension, and diabetes only.

19396 Insurance Policy Changes

Payment Policy Material Amendment

OfficeLink Updates - April 2026 notices and reminders (PDF)

Medical policy updates

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)

Augmentation Mammoplasty