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PAYER POLICY CHANGES

49250 Insurance Policy Changes

CPT 49250, in plain terms, covers Surgical removal of the umbilicus (navel), typically due to infection, abnormality, or cosmetic concern. CPT 49250 is referenced in 1 tracked payer policy change from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 49250 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 49250 on AAPC

Watch 49250

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • Colorado Medicaid · Effective July 1, 2026

    Prior authorization required

    Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column)

  • 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 49250?

CalViva Health lists 49250 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 Colorado Medicaid require prior authorization for 49250?

Colorado Medicaid lists 49250 on Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column) for medicaid ffs plans (list dated July 1, 2026). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 49250?

Community Health Plan of Imperial Valley lists 49250 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 49250?

There are 1 tracked policy change affecting CPT 49250, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 49250?

Payers that have issued tracked updates for CPT 49250 include: Aetna.

How do I get notified when CPT 49250 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 49250. 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 49250?

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 49250

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 49250 in one place.

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