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PAYER POLICY CHANGES

21431 Insurance Policy Changes

CPT 21431, in plain terms, covers Surgeon treats a LeFort III type craniofacial separation without an incision, securing it with interdental wire fixation of a denture or splint. CPT 21431 is referenced in 1 tracked payer policy change from Capital Blue Cross. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 21431 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 21431 on AAPC

Watch 21431

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • 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 AmeriHealth Caritas require prior authorization for 21431?

AmeriHealth Caritas lists 21431 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 21431?

CalViva Health lists 21431 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 21431?

Community Health Plan of Imperial Valley lists 21431 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 21431?

There are 1 tracked policy change affecting CPT 21431, including updates from Capital Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 21431?

Payers that have issued tracked updates for CPT 21431 include: Capital Blue Cross.

How do I get notified when CPT 21431 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 21431. 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 21431?

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 21431

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 21431 in one place.

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