What insurance policy changes affect CPT 77046?

There are 7 tracked policy changes affecting CPT 77046, including updates from Aetna, Humana, Wisconsin Medicaid (ForwardHealth). Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 77046?

Payers that have issued tracked updates for CPT 77046 include: Aetna, Humana, Wisconsin Medicaid (ForwardHealth), Sentara Health Plans, Texas Medicaid.

How do I get notified when CPT 77046 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 77046. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 77046?

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.

77046 — An MRI scan of one breast to look for abnormalities or evaluate breast tissue.: Insurance Policy Changes

77046 Insurance Policy Changes

CPT 77046, in plain terms, covers An MRI scan of one breast to look for abnormalities or evaluate breast tissue. CPT 77046 is referenced in 7 tracked payer policy changes from Aetna, Humana, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 77046 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Magnetic Resonance Imaging (MRI) of the Breast (CPB 0105, reviewed 2026-08-06)

Aetna·Effective Aug 6, 2026

This is a comprehensive Aetna clinical policy bulletin for breast MRI (CPT 77046-77049) that outlines extensive covered indications, experimental/non-covered uses, and billing code guidance. The policy was reviewed on 2026-08-06 and establishes specific medical necessity criteria for breast MRI with or without contrast, including oncologic staging, implant evaluation, high-genetic-risk screening, and post-treatment surveillance. Billing teams must ensure claims align with the defined covered indications and avoid submitting claims for experimental/investigational indications listed in the policy.

77046 Insurance Policy Changes

Magnetic Resonance Imaging (MRI) of the Breast (CPB 0105, reviewed 2026-08-06)

Breast Imaging - Medicare Advantage (Revised)

Prior Authorization No Longer Required for Certain Advanced Breast Imaging Procedure Codes

Breast Imaging - Medicare Advantage (Revised)

Breast Biopsy Procedures (CPB 0269, reviewed 2026-05-14)

Authorization Updates - Effective May 1, 2026

Updates to Prior Authorization for Services and Clinician-Administered Drug Benefits for HTW/HTW Plus