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Billing codes
45390

PAYER POLICY CHANGES

45390 Insurance Policy Changes

CPT 45390, in plain terms, covers Colonoscopy with endoscopic mucosal resection of one or more lesions. CPT 45390 is referenced in 10 tracked payer policy changes from Blue Cross Blue Shield of Vermont, UnitedHealthcare, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 45390 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 45390 on AAPC

Blue Cross Blue Shield of Vermont · Effective Dec 1, 2026High impact
Preventive Care Reminder Sent to Members
Members receive the preventive services listed here at no cost when they align with USPSTF A- and B-rated services, ACIP vaccine recommendations, HRSA infant, child, adolescent and women's preventive guidelines, and Vermont state mandates. Covered procedure and diagnosis codes are listed for screenings, counseling, vaccines and preventive medications for children, adults and pregnant members, and some services require prior approval. Recent revisions add a Pre-Diabetes Preventive Interventions section for adults 18 and older, split mammography into diagnostic, ultrasound and MRI sections, and add pregnancy diagnosis codes effective 12/01/2026.
UnitedHealthcare · Effective Dec 1, 2026Medium impact
Outpatient Surgical Procedures – Site of Service
UnitedHealthcare is removing a long list of CPT codes from the applicable-code list of its Outpatient Surgical Procedures site-of-service policy for Exchange plans, and it is also removing the link to the Manipulation Under Anesthesia policy. The change takes effect December 1, 2026. The source does not state a new billing requirement for the removed codes.
UnitedHealthcare · Effective Dec 1, 2026Medium impact
Outpatient Surgical Procedures – Site of Service
Effective December 1, 2026, UMR removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, UMR's site-of-service policy no longer applies, so the practice should update its internal UMR site-of-service and prior authorization lists before that date.
UnitedHealthcare · Effective Dec 1, 2026Medium impact
Outpatient Surgical Procedures – Site of Service
Effective December 1, 2026, UnitedHealthcare removes more than 500 CPT codes from its Outpatient Surgical Procedures - Site of Service medical policy for commercial plans, and it drops a reference link to the Manipulation Under Anesthesia policy. For those codes, the site-of-service policy no longer applies under this UnitedHealthcare commercial policy, so the practice should update its internal site-of-service and prior authorization lists before that date.
BCBS Arizona · Effective Sep 1, 2026High impact
Site of Service for Outpatient Procedures
This policy, effective 09/01/26, requires site-of-service review and, when applicable, prior authorization for specified outpatient procedures performed in a hospital outpatient setting, and the lowest appropriate level of care capable of safely performing the procedure is preferred in the absence of a clinical contraindication. A hospital outpatient facility instead of an ambulatory surgery center for a planned outpatient procedure is medically necessary with documentation of ANY of 38 listed criteria, including age 18 years or younger, prolonged surgery (>3 hours), morbid obesity (BMI 40 or higher), pregnancy, ASA Physical Status classification III or higher, moderate to severe obstructive sleep apnea, or uncontrolled epilepsy. The policy covers specified musculoskeletal, digestive and urinary system CPT codes.
Aetna · Effective Jul 1, 2025High impact
OfficeLink Updates - April 2025 notices and reminders (PDF)
Aetna updated their National Precertification List with multiple new drug requirements and removed precertification for BRCA genetic testing. Several new specialty drugs now require precertification with staggered effective dates from March through April 2025, and new claim edits will be implemented starting July 1, 2025.
Blue Cross Blue Shield of Vermont · Identified Sep 29, 2026High impact
Contraceptive Counseling Reminder
Blue Cross Vermont's preventive care benefit covers the screenings, vaccines, medications and counseling it lists at no cost when they align with the USPSTF, ACIP, HRSA and Vermont recommendations, and it lists the CPT, HCPCS and ICD-10-CM codes that qualify. Several revisions are already in effect: obstetric professional care after 09/01/2026 is billed with an E/M code and modifier -TH, branded oral contraceptives can only be dispensed when no commercially available generic equivalent exists, and the adult mammography, breast ultrasound and breast MRI sections added diagnosis codes including N63.15, N63.25 and Z12.31 effective 08/01/2026. Other revisions add pre-diabetes preventive interventions, a weight loss behavioral intervention section, influenza code 90616 to the adult vaccine section, diabetes screening age banding changed from 40 to 35, and pregnancy diagnosis codes with a 12/01/2026 effective date.
Premera Blue Cross · Identified Jun 16, 2026High impact
Medical Policy and Coding Updates - December 2024
Premera's December 2024 medical policy and coding update adds medical necessity criteria for lymphedema and lipedema surgery, a new shoulder arthroplasty policy, and new or revised criteria for drugs including Ocrevus Zunovo, Dupixent, Ebglyss, Leqselvi and Wegovy. It also lists coding updates that require review for medical necessity and prior authorization, including cervical spine surgery codes 63001, 63015, 63040, 63050, 63051, 63075, 63081 and 63265, and it places infusion drugs such as Tyruko and Alyglo under site-of-service review.
Regence BlueShield · Effective Nov 1, 2026Medium impact
Surgical Site of Care - Colonoscopy and Sigmoidoscopy
Effective November 1, 2026, the Surgical Site of Care policy for colonoscopy and sigmoidoscopy codes applies site of care medical necessity review only when the procedure is performed in an outpatient hospital setting. Use of a hospital outpatient department instead of an ambulatory surgery center or physician office may be considered medically necessary when one or more listed criteria are met, such as no geographically accessible in-network ASC that has the necessary equipment, a procedure that requires discontinuing medications that necessitate inpatient monitoring, ASA Physical Status III or higher, or a BMI over 40. When none of the criteria are met, hospital outpatient use is considered not medically necessary.
Regence BlueShield · Effective Nov 1, 2026Medium impact
Surgical Site of Care - Colonoscopy
Effective November 1, 2026, use of a hospital outpatient department instead of an ambulatory surgery center or physician office for surgical services may be considered medically necessary when one of the listed criteria is met, such as no geographically accessible in-network ASC within 25 miles of the individual's residence that has the necessary equipment, a procedure that requires discontinuing medications that necessitate inpatient monitoring, an American Society of Anesthesiologists Physical Status classification of III or higher, a body mass index over 40, or a prolonged surgery over 3 hours. Site of care medical necessity reviews apply to the listed colonoscopy, sigmoidoscopy and colorectal screening codes only when they are performed in an outpatient hospital setting, and use of a hospital outpatient department when the criteria are not met is considered not medically necessary.

Watch 45390

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REFERENCE DATA

Payers with rules7

Payers requiring prior auth7

Anthem BCBS · Effective October 19, 2026
Prior authorization required
Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial)
BCBS Arizona · Effective October 1, 2026
Prior authorization required in some cases
AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026)
Ambetter · Effective December 31, 2025
Prior authorization required
Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 45390?

Ambetter lists 45390 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 45390?

Anthem BCBS lists 45390 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 Arizona Complete Health require prior authorization for 45390?

Arizona Complete Health lists 45390 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for 45390?

BCBS Arizona lists 45390 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans, with conditions (list dated October 1, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 45390?

CalViva Health lists 45390 on CalViva Health 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 45390?

There are 10 tracked policy changes affecting CPT 45390, including updates from Blue Cross Blue Shield of Vermont, UnitedHealthcare, BCBS Arizona. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 45390?

Payers that have issued tracked updates for CPT 45390 include: Blue Cross Blue Shield of Vermont, UnitedHealthcare, BCBS Arizona, Aetna, Premera Blue Cross, Regence BlueShield.

How do I get notified when CPT 45390 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 45390. 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 45390?

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 45390 in one place.

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All billing codes J3590 C9399 J3490 99215 99213 99202

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Preventive Care Reminder Sent to Members

Outpatient Surgical Procedures – Site of Service

Outpatient Surgical Procedures – Site of Service

Outpatient Surgical Procedures – Site of Service

Site of Service for Outpatient Procedures

OfficeLink Updates - April 2025 notices and reminders (PDF)

Contraceptive Counseling Reminder

Medical Policy and Coding Updates - December 2024

Surgical Site of Care - Colonoscopy and Sigmoidoscopy

Surgical Site of Care - Colonoscopy

Prior authorization required

Prior authorization required in some cases

Prior authorization required

Does Ambetter require prior authorization for 45390?

Does Anthem BCBS require prior authorization for 45390?

Does Arizona Complete Health require prior authorization for 45390?

Does BCBS Arizona require prior authorization for 45390?

Does CalViva Health require prior authorization for 45390?

What insurance policy changes affect CPT 45390?

Which payers have updated policy for CPT 45390?

How do I get notified when CPT 45390 policy changes?

Why do payers change policies for CPT 45390?