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PAYER POLICY CHANGES

49188 Insurance Policy Changes

CPT 49188, in plain terms, covers Open surgery to cut out or destroy tumors, cysts or endometriomas inside the abdomen, retroperitoneum or mesentery. Choose this tier when the largest one measures 10.1 to 20 cm. CPT 49188 is referenced in 1 tracked payer policy change from Blue Cross and Blue Shield of Louisiana. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 49188 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 49188 on AAPC

Watch 49188

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REFERENCE DATA

Payers with rules2
Payers requiring prior auth2
  • 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 CalViva Health require prior authorization for 49188?

CalViva Health lists 49188 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 49188?

Community Health Plan of Imperial Valley lists 49188 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 49188?

There are 1 tracked policy change affecting CPT 49188, including updates from Blue Cross and Blue Shield of Louisiana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 49188?

Payers that have issued tracked updates for CPT 49188 include: Blue Cross and Blue Shield of Louisiana.

How do I get notified when CPT 49188 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 49188. 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 49188?

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 49188

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 49188 in one place.

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