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PAYER POLICY CHANGES

36415 Insurance Policy Changes

CPT 36415 is referenced in 15 tracked payer policy changes from Blue Cross Blue Shield of Vermont, Independence Blue Cross, and 9 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 36415 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Watch 36415

Get one email when a payer policy names 36415, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

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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 36415?

CalViva Health lists 36415 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 36415?

Community Health Plan of Imperial Valley lists 36415 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 36415?

There are 15 tracked policy changes affecting CPT 36415, including updates from Blue Cross Blue Shield of Vermont, Independence Blue Cross, Capital Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 36415?

Payers that have issued tracked updates for CPT 36415 include: Blue Cross Blue Shield of Vermont, Independence Blue Cross, Capital Blue Cross, Arizona Medicaid - AHCCCS, Medicare/CMS - Transmittals, BCBS Illinois, BCBS New Mexico, Indiana Medicaid (IHCP), Nevada Medicaid, Aetna, Maryland Medicaid.

How do I get notified when CPT 36415 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 36415. 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 36415?

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 36415

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 36415 in one place.

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RELATED

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