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PAYER POLICY CHANGES

23405 Insurance Policy Changes

CPT 23405, in plain terms, covers Surgeon makes an open cut through a single shoulder tendon and muscle to release or lengthen it. CPT 23405 is referenced in 2 tracked payer policy changes from Blue Cross Blue Shield of Nebraska. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 23405 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 23405 on AAPC

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REFERENCE DATA

Payers with rules8
Payers requiring prior auth8
  • 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)

  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter Health of Delaware CMS-0057-F prior authorization requirements

  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 23405?

Ambetter lists 23405 on Ambetter Health of Delaware CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for 23405?

BCBS Michigan lists 23405 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 23405?

CalViva Health lists 23405 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 23405?

Capital Blue Cross lists 23405 on Capital Blue Cross single source preauthorization code list for commercial plans, with conditions. Verify with the payer before scheduling.

Does Centene require prior authorization for 23405?

Centene lists 23405 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance 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 23405?

There are 2 tracked policy changes affecting CPT 23405, including updates from Blue Cross Blue Shield of Nebraska. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 23405?

Payers that have issued tracked updates for CPT 23405 include: Blue Cross Blue Shield of Nebraska.

How do I get notified when CPT 23405 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 23405. 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 23405?

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 23405

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 23405 in one place.

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