What insurance policy changes affect CPT 37243?

There are 8 tracked policy changes affecting CPT 37243, including updates from Blue Cross Blue Shield of Rhode Island, PacificSource Health Plans, Health Net. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

How do I get notified when CPT 37243 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 37243. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 37243?

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.

37243 — A procedure to intentionally block blood vessels supplying an organ to stop bleeding or treat a disease.: Insurance Policy Changes

Q: Which payers have updated policy for CPT 37243?

Payers that have issued tracked updates for CPT 37243 include: Blue Cross Blue Shield of Rhode Island, PacificSource Health Plans, Health Net, Humana, Blue Cross & Blue Shield of Mississippi.

37243 Insurance Policy Changes

CPT 37243, in plain terms, covers A procedure to intentionally block blood vessels supplying an organ to stop bleeding or treat a disease. CPT 37243 is referenced in 8 tracked payer policy changes from Blue Cross Blue Shield of Rhode Island, PacificSource Health Plans, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 37243 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Prior authorization changes for February 1, 2026 – Medicare and Medicaid

PacificSource Health Plans·Effective Feb 1, 2026

Effective February 1, 2026, PacificSource is implementing new prior authorization requirements for Medicare and Medicaid. Medicare adds 20 procedure codes requiring prior auth (including arthroscopy, unlisted procedures, and specialized diagnostics) plus 3 codes requiring prior auth only when claims exceed $500. Medicaid adds 2 codes requiring prior auth. Billing teams must update systems and verify all affected codes before service delivery to avoid claim denials.

37243 Insurance Policy Changes

Medical policy updates

Prior authorization changes for February 1, 2026 – Medicare and Medicaid

25-997 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

25-998 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

Uterine Fibroid Surgical Treatments - Medicare Advantage (Revised)

Prostate Artery Embolization for Benign Prostatic Hyperplasia

25-996 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

Occlusion of Uterine Arteries Using Transcatheter Embolization