45392 Insurance Policy Changes

CPT 45392, in plain terms, covers Colonoscopy with ultrasound guidance to take a needle aspiration or biopsy sample from within or through the colon wall. CPT 45392 is referenced in 5 tracked payer policy changes from BCBS Arizona, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 45392 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 45392 on AAPC

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.
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.
Aetna · Identified Aug 14, 2026Medium impact
Endoscopic Ultrasonography (CPB 0446, reviewed 2026-07-22)
Aetna's Clinical Policy Bulletin 0446 sets coverage rules for endoscopic ultrasonography (EUS). Aetna considers EUS medically necessary for listed indications, including diagnosing common bile duct stones, evaluating abnormalities of the biliary tree and pancreas, staging tumors of the gastrointestinal tract, pancreas and bile ducts, staging lung cancer with fine-needle aspiration, pancreatic cancer screening in individuals with genetic susceptibility, and endoscopic ultrasound-guided biliary drainage for palliation of malignant biliary obstruction. EUS is considered experimental, investigational or unproven for all other indications, including diagnosis of esophageal varices, EUS-elastography, evaluation of common bile duct dilation in persons without signs or symptoms, and EUS-guided ablation therapies for pancreatic cystic neoplasms.

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REFERENCE DATA

Payers with rules3

Payers requiring prior auth3

BCBS Arizona · Effective October 1, 2026
Prior authorization required in some cases
AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026)
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 BCBS Arizona require prior authorization for 45392?

BCBS Arizona lists 45392 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 45392?

CalViva Health lists 45392 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 45392?

Community Health Plan of Imperial Valley lists 45392 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 45392?

There are 5 tracked policy changes affecting CPT 45392, including updates from BCBS Arizona, Aetna, Regence BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 45392?

Payers that have issued tracked updates for CPT 45392 include: BCBS Arizona, Aetna, Regence BlueShield.

How do I get notified when CPT 45392 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 45392. 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 45392?

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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All billing codes J3590 C9399 J3490 99215 99213 99202

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Site of Service for Outpatient Procedures

OfficeLink Updates - April 2025 notices and reminders (PDF)

Surgical Site of Care - Colonoscopy and Sigmoidoscopy

Surgical Site of Care - Colonoscopy

Endoscopic Ultrasonography (CPB 0446, reviewed 2026-07-22)

Prior authorization required in some cases

Prior authorization required