CPT 64999 is referenced in 48 tracked payer policy changes from Sentara Health Plans, UnitedHealthcare, and 9 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 64999 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Effective 2026-12-01, the Surest medical policy on occipital nerve injections and ablation removes greater occipital nerve block injections of local anesthetics and/or steroids from both the proven list for pain from head and neck malignancy and the unproven list for occipital neuralgia and headaches (including migraine and cervicogenic headache), and it removes occipital neurectomy from the unproven list. CPT/HCPCS codes 64405, 64570, 64575, 64771, 64999 and A4540 are also removed from the applicable codes list, and the neurectomy definition is deleted. Billing teams should review how these services are scheduled and billed for Surest members starting that date.
UnitedHealthcare Community Plan of North Carolina's November 2026 Medicaid medical policy update for Bariatric Surgery removed CPT 43882 from the applicable codes list. The update also notes that CPT codes 43659, 43772, 43889, 43999, and 64999 are not on the State of North Carolina Medicaid Fee Schedule and therefore may not be covered by the North Carolina Medicaid Program. Practices should update charge entry and claim edits for these codes for North Carolina Community Plan members.
Humana revised its Medicare Advantage Spinal Decompression Surgery coverage policy (HUM-1216-006), with an effective date of 11/02/2026 and an annual review dated 10/13/2026. The revision updates coverage criteria for discectomy, laminectomy/laminotomy/foraminectomy/foraminotomy, laminoplasty and corpectomy, adds coverage limitations excluding several percutaneous and laser discectomy techniques, annular closure, and AI/augmented-reality-guided decompression, and updates coding information including new 2026 codes 62330, 62331 and 63032.
Capital Blue Cross updated its medical policies with an effective date of November 1, 2026 unless otherwise indicated, and many revisions take effect December 1, 2026. Changes include new prior authorization for J9999 and C9399 (Sarclisa Escena) effective November 1, 2026, and for J9041, J9046, J9048, J9049, J9054 and J9999 (bortezomib) and J9292 (Axtle) effective December 1, 2026, along with new step therapy requirements for several drugs. Other revisions remove prior authorization for procedure codes 34701, 34703, 34705, 34707, 96920, 96921, 96922 and 64566, add prior authorization for 17106, 17107 and 17108, and list L2006 as non-covered once it is removed from prior authorization.
Humana Medicare Advantage has updated its carpal tunnel syndrome surgical treatment policy (effective 10/01/2026) to cover only endoscopic or open carpal tunnel release surgery (CPT 29848, 64721) when specific medical necessity criteria are met. The policy explicitly excludes coverage for thread carpal tunnel release (TCTR), ultrasound-guided percutaneous carpal tunnel release (PCTR), balloon carpal tunnelplasty (BCTP), and code 64728, stating insufficient evidence for these procedures.
Humana Medicare Advantage has updated its carpal tunnel syndrome surgical treatment coverage policy (effective 08/03/2026). The policy now specifies that only endoscopic or open carpal tunnel release surgery (CPT 29848, 64721) is covered when strict medical necessity criteria are met. Alternative surgical techniques (TCTR, PCTR, balloon carpal tunnelplasty) and adjunctive procedures (epineurotomy, flexor tenosynovectomy, neurolysis, flexor retinaculum reconstruction) are explicitly NOT covered due to insufficient evidence.
Independence Blue Cross updated its Experimental/Investigational Services policy effective 07/01/2026, adding 32 new CPT codes, 3 new HCPCS codes, and 2 new unlisted code services (VersaWrap and Stravix Nerve Wrap) to the non-covered list, while removing 6 CPT codes and 1 HCPCS code that are now eligible for coverage. Billing teams must update claims systems to deny claims for newly added experimental codes and allow claims for newly eligible codes.
Independence Blue Cross updated its Experimental/Investigational Services policy effective 07/01/2026, adding 30 new CPT codes, 3 new HCPCS codes, and 2 unlisted service categories (VersaWrap and Stravix Nerve Wrap) to the non-covered list. Additionally, 5 CPT codes, 3 HCPCS codes were removed as now eligible for coverage, and 1 CPT code was terminated. Billing teams must update their denial rules and billing software to reflect these changes immediately.
Effective February 1, 2026, PacificSource is implementing new prior authorization requirements for Medicare and Medicaid. Medicare adds 20 procedure codes requiring prior auth (including arthroscopy, unlisted procedures, and specialized diagnostics) plus 3 codes requiring prior auth only when claims exceed $500. Medicaid adds 2 codes requiring prior auth. Billing teams must update systems and verify all affected codes before service delivery to avoid claim denials.
Community Health Plan of Imperial Valley is updating prior authorization requirements effective December 1, 2025, removing PA requirements for many services including genetic testing, oxygen supplies, and various surgical procedures, while maintaining or adding PA requirements for specific services like TMS therapy and certain hernia repairs.
Health Net California is updating prior authorization requirements effective December 1, 2025, removing PA requirements for some services while adding requirements for others. Key changes include removing PA requirements for ABA therapy, physical therapy, and genetic testing while maintaining PA requirements for TMS, certain surgeries, and specific pharmaceuticals.
Independence Blue Cross added a long list of CPT, HCPCS and unlisted codes to its experimental/investigational list under commercial policy 12.01.01bv, which means these services are not covered under the medical benefit, retroactive to October 1, 2026. It also removed some codes from that list because they are now considered eligible (52284, 55868 and a brain catheter placement code) and moved basivertebral nerve ablation and bioengineered skin substitutes to other IBX policies. The notice lists CPT 64999 both as added (for the Avance nerve graft) and removed (for stereotactic brain catheter placement), so confirm that code with IBX before billing it.
Percutaneous electrical neurostimulation, percutaneous neuromodulation therapy, and restorative neurostimulation therapy (ReActiv8) are each considered investigational. CPT code 1088T, for percutaneous application of high-frequency neuromodulation signals using a microneedle electrode array for nociceptive or neuropathic pain, was added with a date of 10/01/2026. Do not report 1088T in conjunction with CPT 64553, 64555, 97032, 97813, 97814, or 0278T.
Implanted vagus nerve stimulation is medically appropriate as a treatment for medically refractory seizures, and it is investigational as a treatment for depression or any other non-epileptic condition. Vagus nerve stimulation implants that detect and stimulate based on increased heart rate, such as the AspireSR Model, are investigational for all indications, and vagus nerve blocking therapy is investigational as a treatment for morbid obesity. The August 20, 2026 update was an annual review with the policy intent unchanged.
Blue Shield of California's medical policy 7.01.106 Tibial Nerve Stimulation has an effective date of August 1, 2026. The policy statement now describes implantable tibial nerve stimulation delivered by an implantable peripheral neurostimulator system (e.g., eCoin, Altaviva) as investigational for all indications, including non-neurogenic urinary dysfunction including overactive bladder, where the previous version used the term subcutaneous. Percutaneous tibial nerve stimulation may be considered medically necessary for an initial 12-week course for non-neurogenic urinary dysfunction including overactive bladder after failed behavioral therapy (8 to 12 weeks) and failed pharmacologic therapy (4 to 8 weeks), and monthly maintenance therapy may be considered after an initial course that resulted in improved urinary dysfunction meeting treatment goals.
Effective July 16, 2026, radiofrequency ablation or denervation of genicular nerves, including cooled and pulsed forms, is considered investigational for all indications, including knee pain and knee osteoarthritis. Cryoneurolysis or cryoablation for knee osteoarthritis pain or pain associated with total knee arthroplasty is considered investigational. Adding an IPACK block to multimodal analgesia to reduce postoperative pain or improve functional performance is considered investigational. The annual review on July 16, 2026 left the policy intent unchanged.
Humana Medicare Advantage has revised its prostatectomy coverage policy (effective 07/01/2026) to clearly define medical necessity criteria: prostatectomy is covered for localized prostate cancer (T1-T3) without fixation OR salvage therapy following radiation/brachytherapy/cryotherapy failure, provided patients have ≥10 year life expectancy, no distant metastases, and no regional lymph node involvement. Nerve grafts (CPT 64999) to prevent erectile dysfunction remain non-covered. Two new laparoscopic prostatectomy codes (55869, new effective 1/1/2026) have been added to the covered procedure list.
Excellus BlueCross BlueShield medical policy 1.01.60, Implantable and Invasive Neuromodulation Systems, is a new policy with an effective date of May 21, 2026, and its content was derived from policy 1.01.55, Electrical Stimulation as a Treatment for Pain and Other Medical Conditions. Permanent peripheral nerve stimulation (PNS) systems, temporary PNS systems such as SPRINT, restorative neurostimulation such as ReActiv8, and percutaneous electrical nerve stimulation or percutaneous neuromodulation therapy (PENS/PNT) are all investigational under this policy. The policy does not address sacral, spinal cord/dorsal column stimulation or tibial nerve stimulation.
BCBSMS policy A.7.01.126 considers image-guided minimally invasive spinal decompression investigational. For FEP subscribers only, image-guided minimally invasive lumbar decompression for central stenosis without nerve root compression or disc herniation is considered medically necessary. Effective 01/01/2026, the Code Reference section adds CPT 62330 and 62331 for percutaneous decompression with partial removal of the ligamentum flavum, which the policy lists as investigational codes.
CalViva Health is streamlining prior authorization requirements effective December 1, 2025, removing PA requirements for several services including oxygen, genetic testing, and certain surgeries while maintaining PA for others like TMS and specific cardiovascular procedures. This affects Medi-Cal providers in Fresno, Kings, and Madera counties in California.
Excellus BlueCross BlueShield has updated their electrical stimulation policy, establishing strict criteria for TENS device coverage requiring 3+ months of pain, failed conservative treatments, and 30-day trial efficacy. The policy also clarifies that many electrical stimulation modalities including functional electrical stimulation and peripheral nerve stimulation are considered investigational and not covered.
Sentara Health Plans' authorization updates effective November 1, 2025 archived the Apixaban (Eliquis) Drug Level policy (Medical 303), Corneal Procedures (Surgical 55) and Percutaneous Transluminal Coronary Lithotripsy for all lines of business, and archived Injectable Hormone Pellets (Medical 157) for Commercial and Medicaid. The same date archived the Substernal Implantable Cardioverter-Defibrillator (Surgical 130) and Thermal Intradiscal Procedures (Surgical 79) policies for Commercial and Medicaid, renamed the subcutaneous defibrillator policy Subcutaneous and Substernal Implantable Cardioverter-Defibrillator, and set authorization required (Y) for codes 28446 and 29891 and for J8597 (Commercial). Criteria were also updated for Commercial and Medicaid for compression stockings, leadless cardiac pacemakers, skin and tissue substitutes, and spinal and other pain management procedures.
Sentara Health Plans' authorization updates effective October 1, 2025 archived several policies, including Deep Brain Stimulation (Surgical 74), Electric Bone Growth Stimulation (DME 09), Near-infrared Spectroscopy (Medical 330) and Home Spirometry (DME 23), with the stimulation policies moved into the new Electrical Stimulation policy (Medical 349). On October 1, 2025, prior authorization became required (Y) for 44 listed procedure codes and for codes including 0420U, 0421U, 0435U, 0212U, 0213U, 81500, 81503, 81528, 88230 and 89420, with some codes directed to OncoHealth or Avalon, and 97161 and 97162 require authorization with benefit limits. Earlier updates effective July 1 and August 1, 2025 removed authorization for codes including 98975, 98976, 98977, 98978, 98980 and 98981, and required authorization for Medicaid codes 0253U, 0254U and 0255U.
Independence Blue Cross updated MA05.064b to clarify PENS/PNT coverage criteria based on Medicare guidelines. The policy removes the "Experimental/Investigational" section and reinforces that PENS/PNT are covered ONLY as diagnostic procedures to assess suitability for implantation, not for ongoing treatment. Key clarification: trial period should not exceed 1 month, and patients should not visit providers on a continuing basis for electrical nerve stimulation treatment.
Blue Cross and Blue Shield of Mississippi requires general anesthesia to be reported with CPT anesthesia codes (00100-01999) and the HCPCS Level II anesthesia modifiers, and it will not accept CPT surgical or medicine codes (10020-69999 and 90000 series) with an anesthesia modifier appended. Anesthesia time is reported in minutes with one unit for each 15-minute increment, and the allowable charge is calculated from anesthesia base units, time units, physical status modifier, qualifying circumstances and specialized monitoring. The policy also sets separate rules for epidural catheter placement and daily management, neuraxial labor analgesia, moderate sedation, monitored anesthesia care, regional anesthesia, and CMS-1500 or UB-04 claim filing.
Intra-abdominal vagus nerve blocking therapy is considered investigational in all situations, including the treatment of obesity. The Maestro Rechargeable System was approved by the FDA through the premarket approval process in January 2015 for adults 18 years and older with a BMI of 40 to 45 kg/m2, or a BMI of 35 to 39.9 kg/m2 with one or more obesity-related conditions who have failed at least one supervised weight management program within the past 5 years. The FDA's weight-loss device page describes the Maestro Rechargeable System as no longer marketed as of September 2018. The investigational code listed is CPT 64999 (unlisted procedure, nervous system).
Navigated transcranial magnetic stimulation is considered investigational for all purposes. This includes preoperative evaluation of individuals being considered for brain surgery when localization of eloquent areas of the brain is an important consideration in surgical planning. Federal Employee Program (FEP) may dictate that FDA-approved devices may not be considered investigational and may be assessed only on the basis of medical necessity.
Management of postoperative pain after surgery is included in the attending physician's evaluation and management services, and those charges should not be billed separately. When an anesthesiologist provides continuous or intermittent epidural management, 62318 is payable once on the first day of service and 01996 covers daily management after that day, but both cannot be paid on the same day. IV-PCA is included in the global fee for general anesthesia and its professional services may not be billed separately, while a single narcotic injection given immediately before or after general anesthesia can be billed separately.
Peripheral subcutaneous field stimulation is investigational under this policy. The policy notes it is an off-label use of peripheral nerve stimulation systems that the FDA has approved for chronic pain by targeting one or more peripheral nerves. The 09/09/2026 update revised the description of treatments and left the policy statement unchanged.
Percutaneous intradiscal electrothermal annuloplasty, intradiscal radiofrequency annuloplasty, and intradiscal biacuplasty for chronic discogenic back pain are considered investigational under this BCBS policy. Intraosseous radiofrequency ablation of the basivertebral nerve, such as the Intracept system, for vertebrogenic back pain is also considered investigational. Unlisted spine procedure code 22899 is listed for the Intercept procedure. The policy was last reviewed 09/16/2026 with no changes.
Occipital nerve stimulation is considered investigational for all indications under this policy. The FDA has not cleared or approved any occipital nerve stimulation device for treatment of headache, and the policy addresses potential off-label use. For Federal Employee Program (FEP) members, FDA-approved devices may not be considered investigational and may be assessed only on the basis of medical necessity.
Catheter-based techniques for lysis of epidural adhesions, with or without endoscopic guidance, are considered investigational. This includes mechanical disruption with a catheter and/or injection of hypertonic solutions with steroids, analgesics, or hyaluronidase, used alone or in combination.
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.
A 09/15/2025 policy history entry retitled the policy from Percutaneous and Subcutaneous Tibial Nerve Stimulation to Tibial Nerve Stimulation and added a statement that transcutaneous tibial nerve stimulation (e.g., Vivally System) is investigational for individuals with urge urinary incontinence and urinary urgency. HCPCS codes A4545, E0736 and E0737 were added to the investigational codes table. Percutaneous tibial nerve stimulation is medically necessary for an initial 12-week course for non-neurogenic urinary dysfunction, including overactive bladder, after failed behavioral therapy and failed pharmacologic therapy, and for monthly maintenance after an initial course that resulted in improved urinary dysfunction meeting treatment goals.
Intracavitary balloon catheter brain brachytherapy is considered investigational, alone or as part of a multimodality treatment regimen, for primary or recurrent malignant brain tumors and for metastasis to the brain from primary solid tumors outside the brain. The policy number changed from A.8.01.45 to L.8.01.418 on 10/09/2025, and the policy statements were unchanged. The Federal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational, so those devices may be assessed only on the basis of their medical necessity.
Radiofrequency ablation and ultrasound ablation of the renal sympathetic nerves are considered medically necessary for individuals whose blood pressure remains above 130/80 mmHg despite use of 3 or more antihypertensive medications from 3 classes at maximally tolerated doses, or with intolerance to antihypertensive medications, whose blood pressure remains uncontrolled despite attempting lifestyle modifications. The procedure should only be performed in experienced, specialized centers with multidisciplinary hypertension teams, after shared decision-making about the risks and benefits of treatment with the individual. The policy history records a 10/15/2025 update that changed the listed codes from investigational to medically necessary and added medically necessary statements for radiofrequency and ultrasound ablation.
This Blue Cross Blue Shield Association policy states that microwave ablation of primary or metastatic liver tumors may be considered medically necessary when the tumor is unresectable due to lesion location and/or comorbid conditions and is a single tumor of 5 cm or less or up to 3 nodules of 3 cm or less each. Microwave ablation of primary or metastatic lung tumors may be considered medically necessary when the tumor is unresectable due to lesion location and/or comorbid conditions and is a single tumor of 3 cm or less. Microwave ablation of more than a single lung tumor, and of primary or metastatic tumors other than liver or lung, is considered investigational.
Effective January 1, 2017, primary care providers were required to submit referrals through BCBSRI's web-based referral management tool for members enrolled in BlueCHiP Commercial, BlueCHiP for Medicare Advance and New England Health Plan (NEHP) products. Specialists must have a referral in place before rendering services, and the claim may be denied if services are rendered without a referral entered in the tool. Effective April 1, 2017, insertion of a subcutaneous implantable cardioverter-defibrillator requires prior authorization for Commercial products, and peripheral subcutaneous field stimulation for chronic neuropathic pain is submitted using unlisted CPT 64999.
BCBS updated policy L.7.01.451 changing the policy number from A.7.01.81 to L.7.01.451, but the coverage decision remains unchanged - nerve grafts with radical prostatectomy are still considered investigational and not covered. This is primarily an administrative numbering change with no impact on billing or coverage.
Independence Blue Cross reissued Medicare Advantage policy MA05.064b on 10/28/2026 with no substantive changes to PENS/PNT coverage. The policy clarifies that these procedures are covered only as diagnostic tools to assess suitability for implantation, performed in office/clinic/hospital outpatient settings, with a typical 1-month trial period. The 'Experimental/Investigational' criteria have been deleted and policy language has been refined to align with current Medicare coverage.
Independence Blue Cross reissued Policy 05.00.75a on 2026-10-28 with no substantive changes to coverage. PENS and PNT remain not covered: PENS for diagnostic/assessment purposes is not medically necessary, and PENS/PNT for pain treatment is experimental/investigational. Billing teams should confirm current applicability of this longstanding non-coverage position.
This is a reissue with no material changes to MA11.098. The policy continues to classify migraine deactivation surgery as experimental/investigational and non-covered under Independence Blue Cross Medicare Advantage plans. The most recent reissue was 07/22/2026 with no substantive policy modifications.
This is a routine annual reissue of Independence Blue Cross policy 11.15.24a with no substantive changes. Migraine deactivation surgery remains classified as experimental/investigational and is not covered under commercial medical benefits. No billing workflow changes are required.
Sphenopalatine ganglion blocks are considered investigational for all headache indications, including migraines and non-migraine headaches. The 05/19/2026 update changed the policy description and left the policy statement unchanged. The Federal Employee Program may dictate that FDA-approved devices, drugs or biologics may not be considered investigational, so these devices may be assessed only on the basis of their medical necessity.
This is a reissue with no substantive changes to MA11.098. The policy continues to classify migraine deactivation surgery as experimental/investigational and therefore not covered under Independence Blue Cross Medicare Advantage plans. No billing, coverage, or procedural changes have been made.
Independence Blue Cross reissued policy 05.00.75a on 05/28/2025 confirming that Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT) remain NOT COVERED as either not medically necessary (for diagnostic/assessment use) or experimental/investigational (for pain treatment). This is a reaffirmation of the company's continuing position with no substantive coverage changes; however, practices must ensure claims for these procedures are consistently denied and not submitted for reimbursement.
This is a reissue of Independence Blue Cross policy 11.15.24a with no content changes. The policy confirms that migraine deactivation surgery remains experimental/investigational and is not covered under commercial medical benefits. No changes to billing, coverage, or procedures are required.
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