What insurance policy changes affect CPT 54861?

There are 2 tracked policy changes affecting CPT 54861, including updates from Healthfirst, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 54861?

Payers that have issued tracked updates for CPT 54861 include: Healthfirst, Aetna.

How do I get notified when CPT 54861 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 54861. 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 54861?

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.

PAYER POLICY CHANGES

54861 Insurance Policy Changes

CPT 54861, in plain terms, covers Surgeon removes the entire epididymis on both sides in a single operative session to treat bilateral chronic infection or obstruction. CPT 54861 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 54861 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 54861 on AAPC

Only a small number of policies match this filter. Check back as coverage expands.

Watch 54861

Get one email when a payer policy names 54861, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

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54861 Insurance Policy Changes

Reimbursement Policies Posted October 1, 2026

Vasectomy Procedures and Chronic Scrotal Content Pain (CPB 0027, reviewed 2026-01-27)