What insurance policy changes affect CPT 36247?

There are 10 tracked policy changes affecting CPT 36247, including updates from Humana, Ambetter, Blue Cross Blue Shield of North Dakota. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 36247?

Payers that have issued tracked updates for CPT 36247 include: Humana, Ambetter, Blue Cross Blue Shield of North Dakota, Aetna, Independence Blue Cross.

How do I get notified when CPT 36247 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 36247. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 36247?

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.

36247 — A catheter is inserted into an artery in the abdomen or lower leg to reach smaller blood vessels beyond the main artery.: Insurance Policy Changes

36247 Insurance Policy Changes

CPT 36247, in plain terms, covers A catheter is inserted into an artery in the abdomen or lower leg to reach smaller blood vessels beyond the main artery. CPT 36247 is referenced in 10 tracked payer policy changes from Humana, Ambetter, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 36247 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Optum Payment Integrity - Editing Area: Effective September 1, 2026

Ambetter·Effective Sep 1, 2026

Effective September 1, 2026, Sunflower Health Plan (through Optum) is implementing eight new prepayment claim review editing areas targeting specific billing patterns across Medicare, Marketplace, and Commercial plans. Providers will experience increased requests for medical record submission prior to payment; claims without timely documentation submission will be denied. The editing areas focus on trauma activation coding, high-dollar hardware/lab claims, surgical code cross-matching, EEG coding, incision/drainage procedures, and selective catheter placement.

36247 Insurance Policy Changes

Peripheral Artery Revascularization of the Lower Extremities - Medicare Advantage (Revised)

Optum Payment Integrity - Editing Area: Effective September 1, 2026

Medical Policy Updates

Pelvic Congestion Syndrome Treatments (CPB 0441, reviewed 2026-07-09)

Peripheral Artery Revascularization of the Lower Extremities - Medicare Advantage (Revised)

Uterine Fibroid Surgical Treatments - Medicare Advantage (Revised)

11.06.04k, Uterine Artery Embolization

MA11.079e, Evaluation and Treatment of Erectile Dysfunction (ED)

11.06.04k, Uterine Artery Embolization

11.11.01k, Evaluation and Treatment of Erectile Dysfunction (ED)