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PAYER POLICY CHANGES

23078 Insurance Policy Changes

CPT 23078, in plain terms, covers Surgeon performs radical resection of a shoulder area soft tissue tumor 5 cm or larger, taking wide margins of surrounding tissue. No tracked policy changes reference CPT 23078 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 23078 on AAPC

No policies yet

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

Watch 23078

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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

  • Fidelis Care · Effective December 31, 2025

    Prior authorization required

    Fidelis Care CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 23078?

CalViva Health lists 23078 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 23078?

Community Health Plan of Imperial Valley lists 23078 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 Fidelis Care require prior authorization for 23078?

Fidelis Care lists 23078 on Fidelis Care 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 23078?

No policy changes affecting CPT 23078 have been tracked yet. Check back as coverage expands.

Which payers have updated policy for CPT 23078?

No payer-specific updates have been tracked for CPT 23078 yet.

How do I get notified when CPT 23078 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 23078. 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 23078?

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.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 23078 in one place.

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RELATED

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