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PAYER POLICY CHANGES

21016 Insurance Policy Changes

CPT 21016, in plain terms, covers Wide radical resection of a soft tissue tumor of the face or scalp, taking surrounding healthy tissue with it, for a tumor 2 cm or larger. No tracked policy changes reference CPT 21016 yet. New payer updates are added daily, so check back soon or create a free alert to be notified the moment a change affects this code.

Official descriptor: CPT 21016 on AAPC

No policies yet

No tracked policy changes match this filter yet. New policies are added daily.

Watch 21016

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REFERENCE DATA

Payers with rules2
Payers requiring prior auth2
  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

  • Community Health Plan of Imperial Valley · Effective December 31, 2025

    Prior authorization required

    Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 21016?

CalViva Health lists 21016 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 21016?

Community Health Plan of Imperial Valley lists 21016 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 21016?

No policy changes affecting CPT 21016 have been tracked yet. Check back as coverage expands.

Which payers have updated policy for CPT 21016?

No payer-specific updates have been tracked for CPT 21016 yet.

How do I get notified when CPT 21016 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 21016. 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 21016?

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 21016

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 21016 in one place.

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