CPT 76016, in plain terms, covers Physician or qualified professional assessment of whether a patient's implanted device is safe for an MRI scan, with written determination. CPT 76016 is referenced in 7 tracked payer policy changes from UnitedHealthcare, Premera 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 76016 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 76016 on AAPC
UnitedHealthcare's individual exchange (ACA marketplace) preventive care policy was updated effective October 1, 2026, which is already in effect. The update refreshed the pregnancy ICD-10 diagnosis codes, added several sudden cardiac arrest and death diagnosis codes while removing two, added breast MRI codes 76014 through 76019 and A9573 for completing breast cancer screening, and clarified that certain colonoscopies may need a site of service review.
UnitedHealthcare's commercial preventive care policy was updated effective October 1, 2026, which is already in effect. The update refreshed the pregnancy ICD-10 diagnosis codes, added several sudden cardiac arrest and death diagnosis codes while removing two, added breast MRI codes 76014 through 76019 and A9573 for completing breast cancer screening, and clarified that certain colonoscopies may need a site of service review.
Premera's January 2025 update adds Carelon imaging, genetic testing and radiation oncology guideline changes for dates of service on and after April 20, 2025, and adds new Insulin Therapy and SGLT2 Inhibitors pharmacy policies effective January 1, 2025. It also adds Kisunla to the amyloid antibody policy and lists coding updates that now require review for medical necessity and prior authorization, including amyloid antibody code J0175, folate antimetabolite code J9292, and sickle cell disease code J3392.
UnitedHealthcare updated preventive care coverage effective October 1, 2026, adding new CPT codes for breast MRI screening (76014-76019, A9573), expanding cardiac risk assessment diagnosis codes, and clarifying that certain colonoscopies may require site-of-service review. Multiple ICD-10 diagnosis code lists were updated for pregnancy-related conditions, cardiac conditions, and genetic/family history risk factors.
UnitedHealthcare and Surest updated the Preventive Care Services medical policy, effective October 1, 2026. The changes add or remove diagnosis codes for pregnancy, sudden cardiac arrest and family history, add breast MRI codes used to complete a breast cancer screening, and clarify that some colonoscopies may need a site of service review.
Effective April 1, 2026, Anthem is bundling blood product services (splitting, pooling, thawing, and administration) into facility fees for inpatient settings in Ohio. Facilities can no longer bill these services separately on the same date of service as a room/facility fee or procedure. Six new HCPCS codes have been added to the related coding section.
Already effective July 1, 2025, Louisiana Blue accepts only the CAQH application for professional credentialing and recredentialing, and the Louisiana Standardized Credentialing Application was accepted for participating providers until June 30. Added codes in the Diagnostic and Therapeutic Services and Outpatient Procedure Services code ranges have effective dates of January 1, 2025 and April 1, 2025, including 15013, 15014, 38226 and 38227. For infusion therapy, the prior authorization must include all codes billed, including administration codes, or penalties will be applied to the claim.
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