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PAYER POLICY CHANGES

26105 Insurance Policy Changes

CPT 26105, in plain terms, covers Open arthrotomy of a metacarpophalangeal joint to take a synovial biopsy, reported per joint. CPT 26105 is referenced in 3 tracked payer policy changes from UnitedHealthcare. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 26105 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 26105 on AAPC

Watch 26105

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REFERENCE DATA

Payers with rules2
Payers requiring prior auth2
  • 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 CalViva Health require prior authorization for 26105?

CalViva Health lists 26105 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 Community Health Plan of Imperial Valley require prior authorization for 26105?

Community Health Plan of Imperial Valley lists 26105 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 26105?

There are 3 tracked policy changes affecting CPT 26105, including updates from UnitedHealthcare. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 26105?

Payers that have issued tracked updates for CPT 26105 include: UnitedHealthcare.

How do I get notified when CPT 26105 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 26105. 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 26105?

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 26105

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 26105 in one place.

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