Does BCBS Arizona require prior authorization for 64598?

BCBS Arizona lists 64598 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for 64598?

BCBS Michigan lists 64598 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 Capital Blue Cross require prior authorization for 64598?

Capital Blue Cross lists 64598 on Capital Blue Cross single source preauthorization code list for medicare advantage plans. Verify with the payer before scheduling.

Does Centene require prior authorization for 64598?

Centene lists 64598 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.

Does Elevance Health require prior authorization for 64598?

Elevance Health lists 64598 on List of items and services that require prior authorization (Medicaid TX) for medicaid managed plans (list dated February 11, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 64598?

There are 8 tracked policy changes affecting CPT 64598, including updates from Premera Blue Cross, Capital Blue Cross, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 64598?

Payers that have issued tracked updates for CPT 64598 include: Premera Blue Cross, Capital Blue Cross, Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when CPT 64598 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 64598. 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 64598?

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

64598 Insurance Policy Changes

CPT 64598 is referenced in 8 tracked payer policy changes from Premera Blue Cross, Capital Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 64598 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Premera Blue Cross · Effective Nov 1, 2026High impact
Medical Policy and Coding Updates - November 2026
Premera Blue Cross (WA) published its November 2026 medical policy and coding update. Several changes take effect on different dates: Nov 1, Nov 6, Nov 15, Nov 16, 2026, Dec 3, 2026, Jan 1, 2027, and Feb 5, 2027, including new prior authorization/medical necessity review requirements for specific CPT/HCPCS codes (e.g., 33340, 31240, J1818, J9999, 52284, 17313–17315, 30117, 31242, 31243, S3600, S3601, C9762, C9763) and some codes now considered investigational or non-covered. Because the notice mixes past, current and future effective dates, the billing team should confirm applicability per date and per plan before acting.
Premera Blue Cross · Identified Nov 1, 2026High impact
Medical Policy and Coding Updates - November 2026
Premera's November 2026 Medical Policy and Coding Updates notice lists new, revised, deleted and renumbered medical policies, pharmacy policies and coding changes, with dates from November 1, 2026 through February 5, 2027. Several coding updates list codes that now require review for medical necessity and prior authorization, or are now considered investigational or non-covered. The notice also describes Carelon radiation oncology and genetic testing guideline updates effective November 15, 2026.
Capital Blue Cross · Identified Jun 20, 2026High impact
AB2026-01-003 Medical policies
Capital Blue Cross added preauthorization requirements for Keytruda Qlex (J9999) and Grafapex (J0614), and for new aflibercept, denosumab, IVIG and ustekinumab products under J3590, Q5157, J1599 and Q5137, with the changes effective March 1, 2026. Policy updates effective February 1, 2026 and March 1, 2026 also removed preauthorization for procedure code 48556 for commercial plans and for procedure codes 64596 and 64598 for commercial plans, and for procedure codes 64570 and L8681 for Medicare Advantage.
Blue Cross & Blue Shield of Mississippi · Identified Oct 17, 2026Medium impact
Sacral Nerve Neuromodulation Stimulation
Policy A.7.01.69 states that sacral nerve neuromodulation may be considered medically necessary as a trial for urge incontinence, urgency-frequency syndrome, non-obstructive urinary retention, or overactive bladder when the listed criteria are met, and as a trial for chronic fecal incontinence when its separate criteria are met. Permanent implantation may be considered medically necessary when those criteria are met and a trial stimulation period shows at least 50% improvement in symptoms over at least 48 hours, while chronic constipation, chronic pelvic pain, stress incontinence, and urge incontinence due to a neurologic condition are investigational. The policy was updated on 09/17/2026 to change the device description, renumber the urinary incontinence Criteria A statements, and remove ICD-9 procedure and diagnosis codes from the code reference section.
Aetna · Identified Oct 16, 2026Medium impact
Peripheral Electrical Nerve Stimulation for Pain (CPB 0011, reviewed 2026-10-14)
Aetna considers TENS units medically necessary durable medical equipment when used as an adjunct or alternative to drugs for acute post-operative pain in the first 30 days after surgery, or for certain chronic, intractable pain not adequately responsive to other methods. Peripherally implanted nerve stimulators are considered medically necessary for intractable neuropathic pain when all listed criteria are met. Percutaneous electrical nerve stimulation is considered medically necessary for chronic low back pain secondary to degenerative disc disease for up to a 30-day period within a multi-modality rehabilitation program, and for diabetic neuropathy or neuropathic pain that has not responded to listed medications. Many other electrical stimulation devices and indications are listed as experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Peripheral Electrical Nerve Stimulation for Pain (CPB 0011, reviewed 2026-06-03)
Aetna considers TENS medically necessary durable medical equipment as an adjunct or alternative to drugs for acute post-operative pain in the first 30 days after surgery, or for certain chronic intractable pain not adequately responsive to other methods such as physical therapy and pharmacotherapy. Peripherally implanted nerve stimulators are considered medically necessary for intractable neuropathic pain when the member meets all listed criteria, including a successful percutaneous stimulation trial that resulted in at least a 50% reduction in pain for a minimum of 3 days. TENS for chronic low back pain, PENS for opioid withdrawal, and many other electrical stimulation devices and indications are considered experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Sacral Nerve Neuromodulation/Stimulation
A trial of sacral nerve neuromodulation, using percutaneous nerve stimulation or a temporarily implanted lead, may be considered medically necessary for urge incontinence, urgency-frequency syndrome, non-obstructive urinary retention, or overactive bladder when the listed criteria are met. Permanent implantation may be considered medically necessary when those criteria are met and a trial stimulation period demonstrates at least 50% improvement in symptoms over at least 48 hours. For chronic fecal incontinence, a trial may be considered for more than 2 incontinent episodes on average per week for more than 6 months, or more than 12 months after vaginal childbirth, after documented failure of conventional conservative therapy. Sacral nerve neuromodulation is considered investigational for chronic constipation, chronic pelvic pain, stress incontinence, and urge incontinence due to a neurologic condition. The 09/17/2026 update revised device descriptions, re-numbered the Criteria A statements for urinary incontinence, and removed ICD-9 procedure and diagnosis codes from the code reference.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions
Peripheral nerve stimulation as a treatment for chronic pain is considered investigational under this policy. Peripheral nerve stimulation is a percutaneous system of leads, electrodes, and a pulse transmitter that delivers electrical impulses to peripheral nerves, and a number of these devices have been cleared by the FDA through the 510(k) process. Spinal cord and dorsal root ganglion stimulation are covered in a separate medical policy and are not reviewed in this policy.

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Medical Policy and Coding Updates - November 2026

Medical Policy and Coding Updates - November 2026

AB2026-01-003 Medical policies

Sacral Nerve Neuromodulation Stimulation

Peripheral Electrical Nerve Stimulation for Pain (CPB 0011, reviewed 2026-10-14)

Peripheral Electrical Nerve Stimulation for Pain (CPB 0011, reviewed 2026-06-03)

Sacral Nerve Neuromodulation/Stimulation

Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions

Prior authorization required in some cases

Prior authorization required