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PAYER POLICY CHANGES

23100 Insurance Policy Changes

CPT 23100, in plain terms, covers A surgical opening of the shoulder joint to examine and remove tissue samples for testing. CPT 23100 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 23100 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 23100 on AAPC

Watch 23100

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REFERENCE DATA

Payers with rules4
Payers requiring prior auth4
  • 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)

  • 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 BCBS Michigan require prior authorization for 23100?

BCBS Michigan lists 23100 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 CalViva Health require prior authorization for 23100?

CalViva Health lists 23100 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 Capital Blue Cross require prior authorization for 23100?

Capital Blue Cross lists 23100 on Capital Blue Cross single source preauthorization code list for commercial plans, with conditions. Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 23100?

Community Health Plan of Imperial Valley lists 23100 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 23100?

There are 1 tracked policy change affecting CPT 23100, 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 23100?

Payers that have issued tracked updates for CPT 23100 include: Capital Blue Cross.

How do I get notified when CPT 23100 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 23100. 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 23100?

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 23100

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 23100 in one place.

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