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PAYER POLICY CHANGES

62273 Insurance Policy Changes

CPT 62273, in plain terms, covers Clinician injects the patient's own blood into the epidural space to seal a spinal fluid leak, such as after a dural puncture. CPT 62273 is referenced in 1 tracked payer policy change from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 62273 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 62273 on AAPC

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • Fidelis Care · Effective November 1, 2026

    Prior authorization required in some cases

    Fidelis Care Metal-Level Products authorization grid

  • 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 62273?

CalViva Health lists 62273 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 62273?

Community Health Plan of Imperial Valley lists 62273 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 62273?

Fidelis Care lists 62273 on Fidelis Care Metal-Level Products authorization grid for exchange plans, with conditions (list dated November 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 62273?

There are 1 tracked policy change affecting CPT 62273, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 62273?

Payers that have issued tracked updates for CPT 62273 include: Aetna.

How do I get notified when CPT 62273 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 62273. 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 62273?

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 62273

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 62273 in one place.

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