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PAYER POLICY CHANGES

40806 Insurance Policy Changes

CPT 40806, in plain terms, covers Simple cut of the labial frenum, the band of tissue connecting the inside of the lip to the gum (frenotomy). CPT 40806 is referenced in 3 tracked payer policy changes from Aetna and Independence Blue Cross. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 40806 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 40806 on AAPC

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • Anthem BCBS · Effective February 11, 2026

    Prior authorization required

    List of items and services that require prior authorization (Medicaid IN)

  • 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 Anthem BCBS require prior authorization for 40806?

Anthem BCBS lists 40806 on List of items and services that require prior authorization (Medicaid IN) for medicaid managed plans (list dated February 11, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 40806?

CalViva Health lists 40806 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 40806?

Community Health Plan of Imperial Valley lists 40806 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 40806?

There are 3 tracked policy changes affecting CPT 40806, including updates from Aetna, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 40806?

Payers that have issued tracked updates for CPT 40806 include: Aetna, Independence Blue Cross.

How do I get notified when CPT 40806 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 40806. 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 40806?

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 40806

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 40806 in one place.

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