43332 Insurance Policy Changes

CPT 43332, in plain terms, covers Surgeon repairs a paraesophageal hiatal hernia through an open abdominal incision without mesh, and the repair includes fundoplication if done. Not for neonates. CPT 43332 is referenced in 3 tracked payer policy changes from Regence BlueShield and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 43332 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 43332 on AAPC

Regence BlueShield · Effective Apr 1, 2026Medium impact
Gastroesophageal Reflux Surgery
Initial esophagogastric fundoplication for symptomatic gastroesophageal reflux disease may be considered medically necessary when no paraesophageal hiatal hernia repair is requested or documented, symptoms are unresponsive to lifestyle modifications, a medication requirement is met (a 4-month total trial of proton pump inhibitors that is ineffective, contraindicated or not tolerated, or PPIs used for 12 or more consecutive months within the past 18 months with surgery considered an alternative to long-term medication), and reflux is objectively confirmed by endoscopy or, if endoscopy is normal, by 24-hour ambulatory esophageal pH monitoring or barium swallow. Fundoplication may also be considered medically necessary for children and adolescents age 17 or younger, for individuals with pulmonary fibrosis and symptomatic or asymptomatic reflux, for a confirmed paraesophageal hiatal hernia (Types II-IV), for esophageal myotomy in achalasia, and for repeat fundoplication after a documented mechanical failure. Gastrectomy, gastrojejunostomy as a stand-alone treatment, and hiatal hernia repair without fundoplication are considered investigational for gastroesophageal reflux.
Aetna · Identified Oct 6, 2026Medium impact
Lung Transplantation (CPB 0598, reviewed 2026-09-08)
Aetna considers lung transplantation medically necessary for qualifying conditions including cystic fibrosis, emphysema and alpha-1-antitrypsin deficiency, Eisenmenger's complex, primary pulmonary hypertension, pulmonary fibrosis, sarcoidosis, lymphangioleiomyomatosis with end-stage pulmonary disease, bronchopulmonary dysplasia, and graft-versus-host disease or failed primary lung graft, when the member meets the transplanting institution's selection criteria or, without those criteria, the general and disease-specific criteria in the policy. Cystic fibrosis requires at least 2 listed signs of clinical deterioration, such as decreasing FEV1, FEV1 less than 30% predicted, or recurrent massive hemoptysis, and emphysema requires both hospitalization for COPD exacerbation with hypercapnia in the preceding year and a BODE index of 7 or above. Lung transplantation is considered not medically necessary for malignancy involving the lung, multi-system disease, refractory uncontrolled hypertension, other effective treatments being available, and smoking without 6 months of abstinence.
Aetna · Identified Aug 19, 2026Medium impact
Lung Transplantation (CPB 0598, reviewed 2025-12-02)
Aetna considers lung transplantation medically necessary for qualifying conditions, including cystic fibrosis, emphysema including alpha-1-antitrypsin deficiency, pulmonary fibrosis, pulmonary hypertension, Eisenmenger's complex, sarcoidosis, lymphangioleiomyomatosis, bronchopulmonary dysplasia and graft-versus-host disease, for members who meet the transplanting institution's selection criteria or, where there are none, the general and disease-specific selection criteria. Lung transplantation is considered not medically necessary for contraindications including lung malignancy, multi-system disease, acute or chronic active infection not adequately treated, and smoking, since members with a history of smoking must be abstinent for 6 months before being considered eligible. Lobar lung transplantation, anti-thymocyte globulin for acute cellular rejection and ex vivo lung perfusion for preservation and transplant of donor lungs are considered medically necessary, while AlloSure, Prospera Lung and lung xenotransplantation are considered experimental, investigational or unproven.

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REFERENCE DATA

Payers with rules3

Payers requiring prior auth3

Anthem BCBS · Effective October 19, 2026
Prior authorization required
Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial)
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 43332?

Anthem BCBS lists 43332 on Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial) for commercial plans (list dated October 19, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 43332?

CalViva Health lists 43332 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 43332?

Community Health Plan of Imperial Valley lists 43332 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 43332?

There are 3 tracked policy changes affecting CPT 43332, including updates from Regence BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 43332?

Payers that have issued tracked updates for CPT 43332 include: Regence BlueShield, Aetna.

How do I get notified when CPT 43332 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 43332. 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 43332?

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.

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Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 43332 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Gastroesophageal Reflux Surgery

Lung Transplantation (CPB 0598, reviewed 2026-09-08)

Lung Transplantation (CPB 0598, reviewed 2025-12-02)

Prior authorization required

Prior authorization required

Prior authorization required

Does Anthem BCBS require prior authorization for 43332?

Does CalViva Health require prior authorization for 43332?

Does Community Health Plan of Imperial Valley require prior authorization for 43332?

What insurance policy changes affect CPT 43332?

Which payers have updated policy for CPT 43332?

How do I get notified when CPT 43332 policy changes?

Why do payers change policies for CPT 43332?