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PAYER POLICY CHANGES

43622 Insurance Policy Changes

CPT 43622, in plain terms, covers Remove the entire stomach and create an intestinal pouch of any type to replace it. CPT 43622 is referenced in 2 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 43622 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 43622 on AAPC

Watch 43622

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REFERENCE DATA

Payers with rules1
Payers requiring prior auth1
  • Fidelis Care · Effective December 31, 2025

    Prior authorization required

    Fidelis Care CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Fidelis Care require prior authorization for 43622?

Fidelis Care lists 43622 on Fidelis Care 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 43622?

There are 2 tracked policy changes affecting CPT 43622, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 43622?

Payers that have issued tracked updates for CPT 43622 include: Aetna.

How do I get notified when CPT 43622 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 43622. 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 43622?

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 43622

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 43622 in one place.

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