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PAYER POLICY CHANGES

31237 Insurance Policy Changes

CPT 31237, in plain terms, covers A doctor removes nasal or sinus growths through an endoscope and sends samples to be examined. CPT 31237 is referenced in 6 tracked payer policy changes from Medical Mutual of Ohio, Humana, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 31237 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 31237 on AAPC

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REFERENCE DATA

Payers with rules5
Payers requiring prior auth5
  • 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)

  • Blue Shield of California · Effective October 1, 2026

    Prior authorization required

    Prior Authorization List for Blue Shield of California

FREQUENTLY ASKED QUESTIONS

Does Anthem BCBS require prior authorization for 31237?

Anthem BCBS lists 31237 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 Michigan require prior authorization for 31237?

BCBS Michigan lists 31237 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 Blue Shield of California require prior authorization for 31237?

Blue Shield of California lists 31237 on Prior Authorization List for Blue Shield of California for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 31237?

CalViva Health lists 31237 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 31237?

Community Health Plan of Imperial Valley lists 31237 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 31237?

There are 6 tracked policy changes affecting CPT 31237, including updates from Medical Mutual of Ohio, Humana, Excellus BlueCross BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 31237?

Payers that have issued tracked updates for CPT 31237 include: Medical Mutual of Ohio, Humana, Excellus BlueCross BlueShield, Aetna.

How do I get notified when CPT 31237 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 31237. 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 31237?

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 31237

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 31237 in one place.

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