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PAYER POLICY CHANGES

21435 Insurance Policy Changes

CPT 21435, in plain terms, covers Open treatment of a complicated LeFort III type craniofacial separation using internal fixation, external fixation such as a head cap, halo or intermaxillary fixation, or both. CPT 21435 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 21435 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 21435 on AAPC

Watch 21435

Get one email when a payer policy names 21435, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

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REFERENCE DATA

Payers with rules4
Payers requiring prior auth4
  • CountyCare Health Plan · Effective April 23, 2026

    Prior authorization required

    CountyCare Prior Authorization Look-Up Tool (All Codes)

  • 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 21435?

AmeriHealth Caritas lists 21435 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 21435?

CalViva Health lists 21435 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 21435?

Community Health Plan of Imperial Valley lists 21435 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.

Does CountyCare Health Plan require prior authorization for 21435?

CountyCare Health Plan lists 21435 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 21435?

There are 1 tracked policy change affecting CPT 21435, 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 21435?

Payers that have issued tracked updates for CPT 21435 include: Capital Blue Cross.

How do I get notified when CPT 21435 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 21435. 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 21435?

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 21435

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 21435 in one place.

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RELATED

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