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PAYER POLICY CHANGES

46505 Insurance Policy Changes

CPT 46505, in plain terms, covers Physician injects botulinum toxin into the anal sphincter muscle. CPT 46505 is referenced in 2 tracked payer policy changes from Medicare/CMS - Transmittals and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 46505 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 46505 on AAPC

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REFERENCE DATA

Payers with rules5
Payers requiring prior auth5
  • Anthem BCBS · Effective October 19, 2026

    Prior authorization required

    Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial)

  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements

  • Arizona Complete Health · Effective December 31, 2025

    Prior authorization required

    Arizona Complete Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 46505?

Ambetter lists 46505 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 46505?

Anthem BCBS lists 46505 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 46505?

Arizona Complete Health lists 46505 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 CalViva Health require prior authorization for 46505?

CalViva Health lists 46505 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 46505?

Community Health Plan of Imperial Valley lists 46505 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 46505?

There are 2 tracked policy changes affecting CPT 46505, including updates from Medicare/CMS - Transmittals, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 46505?

Payers that have issued tracked updates for CPT 46505 include: Medicare/CMS - Transmittals, Aetna.

How do I get notified when CPT 46505 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 46505. 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 46505?

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 46505

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 46505 in one place.

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