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PAYER POLICY CHANGES

49520 Insurance Policy Changes

CPT 49520, in plain terms, covers A second surgical repair to fix a hernia that has come back or failed after a previous repair attempt. CPT 49520 is referenced in 5 tracked payer policy changes from Providence Health Plan, New Jersey Medicaid, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 49520 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 49520 on AAPC

Watch 49520

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REFERENCE DATA

Payers with rules4
Payers requiring prior auth4
  • Anthem BCBS · Effective October 19, 2026

    Prior authorization required

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

  • 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 Anthem BCBS require prior authorization for 49520?

Anthem BCBS lists 49520 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 CalViva Health require prior authorization for 49520?

CalViva Health lists 49520 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 49520?

Community Health Plan of Imperial Valley lists 49520 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.

Does Fidelis Care require prior authorization for 49520?

Fidelis Care lists 49520 on Fidelis Care 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 49520?

There are 5 tracked policy changes affecting CPT 49520, including updates from Providence Health Plan, New Jersey Medicaid, Regence BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 49520?

Payers that have issued tracked updates for CPT 49520 include: Providence Health Plan, New Jersey Medicaid, Regence BlueShield.

How do I get notified when CPT 49520 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 49520. 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 49520?

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 49520

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 49520 in one place.

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