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PAYER POLICY CHANGES

58760 Insurance Policy Changes

CPT 58760, in plain terms, covers Surgeon performs open fimbrioplasty to reconstruct the fimbriated end of the fallopian tube. CPT 58760 is referenced in 2 tracked payer policy changes from Sentara Health Plans and Healthfirst. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 58760 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 58760 on AAPC

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • BCBS Michigan · Effective October 13, 2026

    Prior authorization required in some cases

    BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

  • Ambetter · Effective December 31, 2025

    Prior authorization required

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

  • Centene · Effective December 31, 2025

    Prior authorization required

    Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 58760?

Ambetter lists 58760 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 BCBS Michigan require prior authorization for 58760?

BCBS Michigan lists 58760 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

Does Centene require prior authorization for 58760?

Centene lists 58760 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance 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 58760?

There are 2 tracked policy changes affecting CPT 58760, including updates from Sentara Health Plans, Healthfirst. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 58760?

Payers that have issued tracked updates for CPT 58760 include: Sentara Health Plans, Healthfirst.

How do I get notified when CPT 58760 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 58760. 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 58760?

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 58760

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 58760 in one place.

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