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PAYER POLICY CHANGES

77047 Insurance Policy Changes

CPT 77047, in plain terms, covers MRI of both breasts performed without any contrast injection, used to look for abnormalities or help evaluate known breast conditions bilaterally. CPT 77047 is referenced in 17 tracked payer policy changes from Blue Cross Blue Shield of Vermont, Blue Cross Blue Shield of North Dakota, and 10 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 77047 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 77047 on AAPC

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REFERENCE DATA

Payers with rules20
Payers requiring prior auth20
  • Aetna · Effective November 1, 2026

    Prior authorization required in some cases

    Participating provider precertification list for Aetna

  • Anthem BCBS · Effective November 1, 2026

    Prior authorization required

    Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)

  • BCBS Michigan · Effective October 13, 2026

    Prior authorization required in some cases

    BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

FREQUENTLY ASKED QUESTIONS

Does Aetna require prior authorization for 77047?

Aetna lists 77047 on Participating provider precertification list for Aetna for commercial plans, with conditions (list dated November 1, 2026). Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 77047?

Anthem BCBS lists 77047 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 77047?

Arizona Complete Health lists 77047 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for 77047?

BCBS Arizona lists 77047 on AZ Blue Standard Prior Authorization Requirements Code List (Updated 10/01/2026) for commercial plans, with conditions (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for 77047?

BCBS Illinois lists 77047 on 2026 Commercial Outpatient Medical Surgical Prior Authorization Codes for commercial plans, with conditions (list dated January 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 77047?

There are 17 tracked policy changes affecting CPT 77047, including updates from Blue Cross Blue Shield of Vermont, Blue Cross Blue Shield of North Dakota, Wisconsin Medicaid (ForwardHealth). Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 77047?

Payers that have issued tracked updates for CPT 77047 include: Blue Cross Blue Shield of Vermont, Blue Cross Blue Shield of North Dakota, Wisconsin Medicaid (ForwardHealth), Humana, Sentara Health Plans, Capital Blue Cross, Premera Blue Cross, Blue Cross & Blue Shield of Mississippi, Texas Medicaid, Aetna, NY Medicaid, Blue Cross Blue Shield of Rhode Island.

How do I get notified when CPT 77047 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 77047. 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 77047?

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 77047

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 77047 in one place.

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