What insurance policy changes affect CPT 58542?

There are 9 tracked policy changes affecting CPT 58542, including updates from Sentara Health Plans, Highmark, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 58542?

Payers that have issued tracked updates for CPT 58542 include: Sentara Health Plans, Highmark, Independence Blue Cross, Humana.

How do I get notified when CPT 58542 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 58542. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 58542?

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.

58542 — Laparoscopic removal of the uterus when it weighs 250 grams or less.: Insurance Policy Changes

58542 Insurance Policy Changes

CPT 58542, in plain terms, covers Laparoscopic removal of the uterus when it weighs 250 grams or less. CPT 58542 is referenced in 9 tracked payer policy changes from Sentara Health Plans, Highmark, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 58542 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

11.08.19s, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

Independence Blue Cross·Effective Oct 1, 2025

Independence Blue Cross has reissued policy 11.08.19s (now version 11.08.19t) for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy with updated ICD-10 codes effective 10/01/2025. Nine new diagnosis codes have been added to support coverage determinations, including codes for inflammatory breast cancer, genetic susceptibility to fallopian tube malignancy, and family/personal history of fallopian tube cancer. The coverage criteria and medical necessity standards remain unchanged from the prior version.

58542 Insurance Policy Changes

Authorization Updates - Effective January 1, 2026

32 Hysterectomy Codes Removed from Prior Authorization List

MA11.077j, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

11.08.19t, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

Uterine Fibroid Surgical Treatments - Medicare Advantage (Revised)

MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

11.08.19s, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

11.08.19s, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy