What insurance policy changes affect CPT 64999?

There are 12 tracked policy changes affecting CPT 64999, including updates from PacificSource Health Plans, Health Net, 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 64999?

Payers that have issued tracked updates for CPT 64999 include: PacificSource Health Plans, Health Net, Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Humana.

How do I get notified when CPT 64999 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 64999. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 64999?

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.

64999 Insurance Policy Changes

CPT 64999 is referenced in 12 tracked payer policy changes from PacificSource Health Plans, Health Net, and 3 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.

High impact
Prior authorization changes for February 1, 2026 – Medicare and Medicaid
PacificSource Health Plans·Effective Feb 1, 2026
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.
High impact
25-997 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency
Health Net·Effective Dec 1, 2025
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.
High impact
25-998 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency
Health Net·Effective Dec 1, 2025
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.
Medium impact
Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy
Blue Cross & Blue Shield of Mississippi·Effective Jan 1, 2026
Blue Cross Blue Shield policy updated to clarify that percutaneous electrical nerve stimulation, percutaneous neuromodulation therapy, and restorative neurostimulation therapy (ReActiv8) are all considered investigational and not covered. New CPT code 64567 replaces deleted code 0720T effective January 1, 2026.
Medium impact
25-996 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency
Health Net·Effective Dec 1, 2025
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.
Medium impact
Electrical Stimulation as a Treatment for Pain and Other Medical Conditions 1.01.55
Excellus BlueCross BlueShield·Effective Nov 20, 2025
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.
Medium impact
Lysis of Epidural Adhesions
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
Blue Cross Blue Shield Mississippi has updated their policy on lysis of epidural adhesions, maintaining that all catheter-based techniques for breaking up epidural scar tissue (including the Racz procedure) are considered investigational and not covered. The policy affects specific CPT codes used for these pain management procedures.
Low impact
Occipital Nerve Stimulation
Blue Cross & Blue Shield of Mississippi·Effective Aug 4, 2025
BCBS Mississippi updated their policy on occipital nerve stimulation for headaches/migraines, confirming it remains investigational and not covered. The policy updated treatment information for migraines and device details but maintained the same coverage denial stance.
Low impact
Nerve Graft With Radical Prostatectomy
Blue Cross & Blue Shield of Mississippi·Effective Jul 1, 2025
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.
Low impact
Kebilidi (eladocagene exuparvovec-tneq) - Medicare Advantage (Revised)
Humana·Effective Apr 1, 2025
New Medicare Advantage coverage policy for Kebilidi (eladocagene exuparvovec-tneq), a gene therapy for AADC deficiency. This is a brand new policy establishing coverage criteria for this rare neurological condition treatment that requires specialized neurosurgical administration.
Low impact
Navigated Transcranial Magnetic Stimulation
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
This policy confirms that Navigated Transcranial Magnetic Stimulation (nTMS) remains investigational for all purposes, including preoperative brain mapping. The policy was recently updated but maintains the same coverage determination - nTMS is not covered as it's considered investigational.
Low impact
Peripheral Subcutaneous Field Stimulation
Blue Cross & Blue Shield of Mississippi·Identified Jun 20, 2026
This policy confirms that Peripheral Subcutaneous Field Stimulation remains classified as investigational and not covered. The policy was reviewed with no changes, maintaining the existing coverage denial for this chronic pain treatment procedure.

All billing codes J3590 99212 99213 99202 99211 99214

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Prior authorization changes for February 1, 2026 – Medicare and Medicaid

25-997 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

25-998 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

Percutaneous Electrical Nerve Stimulation, Percutaneous Neuromodulation Therapy, and Restorative Neurostimulation Therapy

25-996 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

Electrical Stimulation as a Treatment for Pain and Other Medical Conditions 1.01.55

Lysis of Epidural Adhesions

Occipital Nerve Stimulation

Nerve Graft With Radical Prostatectomy

Kebilidi (eladocagene exuparvovec-tneq) - Medicare Advantage (Revised)

Navigated Transcranial Magnetic Stimulation

Peripheral Subcutaneous Field Stimulation