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PAYER POLICY CHANGES

52320 Insurance Policy Changes

CPT 52320, in plain terms, covers Cystoscopy with removal of a stone from the ureter, such as by basket extraction, without ureteroscopy. CPT 52320 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 52320 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 52320 on AAPC

Watch 52320

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REFERENCE DATA

Payers with rules6
Payers requiring prior auth6
  • Anthem BCBS · Effective October 19, 2026

    Prior authorization required

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

  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements

  • Arizona Complete Health · Effective December 31, 2025

    Prior authorization required

    Arizona Complete Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 52320?

Ambetter lists 52320 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 52320?

Anthem BCBS lists 52320 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 Arizona Complete Health require prior authorization for 52320?

Arizona Complete Health lists 52320 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 52320?

CalViva Health lists 52320 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 52320?

Community Health Plan of Imperial Valley lists 52320 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 52320?

There are 3 tracked policy changes affecting CPT 52320, including updates from UnitedHealthcare. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 52320?

Payers that have issued tracked updates for CPT 52320 include: UnitedHealthcare.

How do I get notified when CPT 52320 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 52320. 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 52320?

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 52320

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 52320 in one place.

See every payer rule

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