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PAYER POLICY CHANGES

23455 Insurance Policy Changes

CPT 23455, in plain terms, covers Open anterior shoulder capsulorrhaphy with repair of the labrum, such as a Bankart procedure. CPT 23455 is referenced in 9 tracked payer policy changes from Excellus BlueCross BlueShield, Blue Cross Blue Shield of Nebraska, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 23455 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 23455 on AAPC

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REFERENCE DATA

Payers with rules17
Payers requiring prior auth17
  • Anthem BCBS · Effective November 1, 2026

    Prior authorization required

    Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)

  • 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)

  • BCBS Arizona · Effective October 1, 2026

    Prior authorization required

    AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Updated 10/01/2026)

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 23455?

Ambetter lists 23455 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 Anthem BCBS require prior authorization for 23455?

Anthem BCBS lists 23455 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for 23455?

BCBS Arizona lists 23455 on AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Updated 10/01/2026) for medicare advantage plans (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for 23455?

BCBS Illinois lists 23455 on 2026 Commercial Outpatient Medical Surgical Prior Authorization Codes for commercial plans, with conditions (list dated January 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for 23455?

BCBS Michigan lists 23455 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.

What insurance policy changes affect CPT 23455?

There are 9 tracked policy changes affecting CPT 23455, including updates from Excellus BlueCross BlueShield, Blue Cross Blue Shield of Nebraska, Premera Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 23455?

Payers that have issued tracked updates for CPT 23455 include: Excellus BlueCross BlueShield, Blue Cross Blue Shield of Nebraska, Premera Blue Cross.

How do I get notified when CPT 23455 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 23455. 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 23455?

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 23455

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 23455 in one place.

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