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PAYER POLICY CHANGES

24361 Insurance Policy Changes

CPT 24361, in plain terms, covers Elbow arthroplasty in which the lower end of the upper arm bone is replaced with a prosthetic component. CPT 24361 is referenced in 2 tracked payer policy changes from Capital Blue Cross and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 24361 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 24361 on AAPC

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REFERENCE DATA

Payers with rules7
Payers requiring prior auth7
  • 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 from Arizona Complete Health CMS-0057-F prior authorization requirements

  • Arizona Complete Health · Effective December 31, 2025

    Prior authorization required

    Arizona Complete Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 24361?

Ambetter lists 24361 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 24361?

Arizona Complete Health lists 24361 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for 24361?

BCBS Michigan lists 24361 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 24361?

CalViva Health lists 24361 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 24361?

Capital Blue Cross lists 24361 on Capital Blue Cross single source preauthorization code list for commercial plans, with conditions. Verify with the payer before scheduling.

What insurance policy changes affect CPT 24361?

There are 2 tracked policy changes affecting CPT 24361, including updates from Capital Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 24361?

Payers that have issued tracked updates for CPT 24361 include: Capital Blue Cross, Aetna.

How do I get notified when CPT 24361 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 24361. 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 24361?

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 24361

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 24361 in one place.

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