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PAYER POLICY CHANGES

21010 Insurance Policy Changes

CPT 21010, in plain terms, covers Opening of the jaw joint through an incision, known as an arthrotomy, to reach the joint space. CPT 21010 is referenced in 6 tracked payer policy changes from Excellus BlueCross BlueShield, Devoted Health, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 21010 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 21010 on AAPC

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REFERENCE DATA

Payers with rules4
Payers requiring prior auth4
  • Aetna · Effective November 1, 2026

    Prior authorization required

    Participating provider precertification list for Aetna

  • Anthem BCBS · Effective November 1, 2026

    Prior authorization required

    Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)

  • 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 Aetna require prior authorization for 21010?

Aetna lists 21010 on Participating provider precertification list for Aetna for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 21010?

Anthem BCBS lists 21010 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 BCBS Michigan require prior authorization for 21010?

BCBS Michigan lists 21010 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 CountyCare Health Plan require prior authorization for 21010?

CountyCare Health Plan lists 21010 on CountyCare Prior Authorization Look-Up Tool (All Codes) for medicaid managed plans (list dated April 23, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 21010?

There are 6 tracked policy changes affecting CPT 21010, including updates from Excellus BlueCross BlueShield, Devoted Health, Humana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 21010?

Payers that have issued tracked updates for CPT 21010 include: Excellus BlueCross BlueShield, Devoted Health, Humana, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 21010 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 21010. 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 21010?

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 21010

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 21010 in one place.

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RELATED

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