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PAYER POLICY CHANGES

65435 Insurance Policy Changes

CPT 65435, in plain terms, covers Removal of the corneal epithelium by scraping or abrasion, which may also include chemical cauterization. CPT 65435 is referenced in 4 tracked payer policy changes from Regence BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 65435 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 65435 on AAPC

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REFERENCE DATA

Payers with rules5
Payers requiring prior auth5
  • Anthem BCBS · Effective October 19, 2026

    Prior authorization required

    Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial)

  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva 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 Anthem BCBS require prior authorization for 65435?

Anthem BCBS lists 65435 on Anthem local precertification/prior authorization list (Colorado | Anthem Blue Cross and Blue Shield | Commercial) for commercial plans (list dated October 19, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 65435?

CalViva Health lists 65435 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 Centene require prior authorization for 65435?

Centene lists 65435 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 Community Health Plan of Imperial Valley require prior authorization for 65435?

Community Health Plan of Imperial Valley lists 65435 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 65435?

Fidelis Care lists 65435 on Fidelis Care 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 65435?

There are 4 tracked policy changes affecting CPT 65435, including updates from Regence BlueShield, Aetna, Colorado Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 65435?

Payers that have issued tracked updates for CPT 65435 include: Regence BlueShield, Aetna, Colorado Medicaid.

How do I get notified when CPT 65435 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 65435. 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 65435?

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 65435

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 65435 in one place.

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