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PAYER POLICY CHANGES

49555 Insurance Policy Changes

CPT 49555, in plain terms, covers A second surgical fix for a femoral hernia that had returned or failed after a previous repair attempt. CPT 49555 is referenced in 3 tracked payer policy changes from Providence Health Plan and New Jersey Medicaid. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 49555 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 49555 on AAPC

Watch 49555

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • 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

  • Fidelis Care · Effective December 31, 2025

    Prior authorization required

    Fidelis Care CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 49555?

CalViva Health lists 49555 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 49555?

Community Health Plan of Imperial Valley lists 49555 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 49555?

Fidelis Care lists 49555 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 49555?

There are 3 tracked policy changes affecting CPT 49555, including updates from Providence Health Plan, New Jersey Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 49555?

Payers that have issued tracked updates for CPT 49555 include: Providence Health Plan, New Jersey Medicaid.

How do I get notified when CPT 49555 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 49555. 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 49555?

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 49555

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 49555 in one place.

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