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PAYER POLICY CHANGES

28515 Insurance Policy Changes

CPT 28515, in plain terms, covers Physician manages a lesser toe phalanx fracture with closed treatment and manipulation, per phalanx. CPT 28515 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 28515 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 28515 on AAPC

Watch 28515

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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 28515?

CalViva Health lists 28515 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 28515?

Community Health Plan of Imperial Valley lists 28515 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 28515?

There are 3 tracked policy changes affecting CPT 28515, including updates from UnitedHealthcare. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 28515?

Payers that have issued tracked updates for CPT 28515 include: UnitedHealthcare.

How do I get notified when CPT 28515 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 28515. 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 28515?

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 28515

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 28515 in one place.

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