What insurance policy changes affect CPT 43236?

There are 14 tracked policy changes affecting CPT 43236, including updates from Anthem BCBS, Aetna, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 43236?

Payers that have issued tracked updates for CPT 43236 include: Anthem BCBS, Aetna, Independence Blue Cross.

How do I get notified when CPT 43236 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 43236. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 43236?

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.

43236 — A doctor uses a camera to look down your throat and injects medicine under the tissue lining to treat an issue.: Insurance Policy Changes

43236 Insurance Policy Changes

CPT 43236, in plain terms, covers A doctor uses a camera to look down your throat and injects medicine under the tissue lining to treat an issue. CPT 43236 is referenced in 14 tracked payer policy changes from Anthem BCBS, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 43236 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

07.02.22j, Esophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)

Independence Blue Cross·Effective Oct 1, 2025

Independence Blue Cross reissued policy 07.02.22j on EGD and ERCP procedures, effective 10/01/2025, with granular ICD-10 code refinements. Specific abdominal and flank pain diagnosis codes (R10.21, R10.22, R10.23, R10.24, R10.85, R10.8A1-A3, R10.8A9, R10.A1-A3, R76.89) are now classified as NOT medically necessary for EGD, replacing broader codes (R10.2, R76.8). Billing teams must update claim denial logic and prior authorization systems to deny EGD claims when these specific diagnosis codes are the sole or primary justification.

43236 Insurance Policy Changes

[California] Precertification/prior authorization requirement changes

[California] Precertification/prior authorization requirement changes

[Virginia] Precertification/prior authorization requirement changes

[California] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Ohio] Precertification/prior authorization requirement changes

[Virginia] Precertification/prior authorization requirement changes

[New York] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Ohio] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

[Georgia] Precertification/prior authorization requirement updates — Carelon Medical Benefits Management

Vocal Cord Paralysis / Insufficiency Treatments (CPB 0253, reviewed 2026-04-15)

07.02.22j, Esophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)

07.02.22j, Esophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)

07.02.22i, Esophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)