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PAYER POLICY CHANGES

52402 Insurance Policy Changes

CPT 52402, in plain terms, covers Physician performs cystoscopy and cuts or resects the ejaculatory ducts transurethrally to relieve obstruction. CPT 52402 is referenced in 2 tracked payer policy changes from Healthfirst and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 52402 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 52402 on AAPC

Watch 52402

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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 52402?

CalViva Health lists 52402 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 52402?

Community Health Plan of Imperial Valley lists 52402 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 52402?

Fidelis Care lists 52402 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 52402?

There are 2 tracked policy changes affecting CPT 52402, including updates from Healthfirst, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 52402?

Payers that have issued tracked updates for CPT 52402 include: Healthfirst, Aetna.

How do I get notified when CPT 52402 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 52402. 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 52402?

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 52402

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 52402 in one place.

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