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PAYER POLICY CHANGES

52007 Insurance Policy Changes

CPT 52007, in plain terms, covers Cystoscopy with ureteral catheterization and brush biopsy of the ureter or renal pelvis, optionally including irrigation or instillation. CPT 52007 is referenced in 3 tracked payer policy changes from UnitedHealthcare. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 52007 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 52007 on AAPC

Watch 52007

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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 52007?

Anthem BCBS lists 52007 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 52007?

CalViva Health lists 52007 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 52007?

Community Health Plan of Imperial Valley lists 52007 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 52007?

Fidelis Care lists 52007 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 52007?

There are 3 tracked policy changes affecting CPT 52007, including updates from UnitedHealthcare. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 52007?

Payers that have issued tracked updates for CPT 52007 include: UnitedHealthcare.

How do I get notified when CPT 52007 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 52007. 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 52007?

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 52007

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 52007 in one place.

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RELATED

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