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PAYER POLICY CHANGES

55821 Insurance Policy Changes

CPT 55821, in plain terms, covers Surgeon removes part of the prostate through a suprapubic incision in one or two stages. CPT 55821 is referenced in 1 tracked payer policy change from Sentara Health Plans. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 55821 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 55821 on AAPC

Watch 55821

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • CountyCare Health Plan · Effective April 23, 2026

    Prior authorization required

    CountyCare Prior Authorization Look-Up Tool (All Codes)

  • 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 CalViva Health require prior authorization for 55821?

CalViva Health lists 55821 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 55821?

Community Health Plan of Imperial Valley lists 55821 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 CountyCare Health Plan require prior authorization for 55821?

CountyCare Health Plan lists 55821 on CountyCare Prior Authorization Look-Up Tool (All Codes) for medicaid managed plans (list dated April 23, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 55821?

There are 1 tracked policy change affecting CPT 55821, including updates from Sentara Health Plans. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 55821?

Payers that have issued tracked updates for CPT 55821 include: Sentara Health Plans.

How do I get notified when CPT 55821 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 55821. 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 55821?

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 55821

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 55821 in one place.

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RELATED

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