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PAYER POLICY CHANGES

66940 Insurance Policy Changes

CPT 66940, in plain terms, covers Extracapsular lens extraction, removing the lens nucleus while leaving the capsule, by a technique not described by other cataract codes. CPT 66940 is referenced in 2 tracked payer policy changes from Blue Cross Blue Shield of Rhode Island and Sentara Health Plans. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 66940 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 66940 on AAPC

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REFERENCE DATA

Payers with rules5
Payers requiring prior auth5
  • Anthem BCBS · Effective February 11, 2026

    Prior authorization required

    List of items and services that require prior authorization (Medicare)

  • 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 66940?

Anthem BCBS lists 66940 on List of items and services that require prior authorization (Medicare) for medicare advantage plans (list dated February 11, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 66940?

CalViva Health lists 66940 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 66940?

Centene lists 66940 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 66940?

Community Health Plan of Imperial Valley lists 66940 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 66940?

Fidelis Care lists 66940 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 66940?

There are 2 tracked policy changes affecting CPT 66940, including updates from Blue Cross Blue Shield of Rhode Island, Sentara Health Plans. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 66940?

Payers that have issued tracked updates for CPT 66940 include: Blue Cross Blue Shield of Rhode Island, Sentara Health Plans.

How do I get notified when CPT 66940 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 66940. 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 66940?

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 66940

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 66940 in one place.

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