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PAYER POLICY CHANGES

49190 Insurance Policy Changes

CPT 49190, in plain terms, covers Open excision or destruction of intra-abdominal, retroperitoneal, or pelvic tumors or cysts when the largest dimension is greater than 30 cm. CPT 49190 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 49190 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 49190 on AAPC

Watch 49190

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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 49190?

CalViva Health lists 49190 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 49190?

Community Health Plan of Imperial Valley lists 49190 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 49190?

There are 1 tracked policy change affecting CPT 49190, 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 49190?

Payers that have issued tracked updates for CPT 49190 include: Blue Cross and Blue Shield of Louisiana.

How do I get notified when CPT 49190 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 49190. 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 49190?

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 49190

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 49190 in one place.

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