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PAYER POLICY CHANGES

24363 Insurance Policy Changes

CPT 24363, in plain terms, covers Total elbow joint replacement in which the surgeon replaces the distal humerus and proximal ulna with prosthetic components. CPT 24363 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 24363 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 24363 on AAPC

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REFERENCE DATA

Payers with rules10
Payers requiring prior auth10
  • 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 24363?

Ambetter lists 24363 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 24363?

Arizona Complete Health lists 24363 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 24363?

BCBS Michigan lists 24363 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 24363?

CalViva Health lists 24363 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 24363?

Capital Blue Cross lists 24363 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 24363?

There are 2 tracked policy changes affecting CPT 24363, 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 24363?

Payers that have issued tracked updates for CPT 24363 include: Capital Blue Cross, Aetna.

How do I get notified when CPT 24363 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 24363. 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 24363?

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 24363

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 24363 in one place.

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