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PAYER POLICY CHANGES

77048 Insurance Policy Changes

CPT 77048, in plain terms, covers MRI of one breast only, with images captured both before and after contrast is injected, including any computer-aided detection processing of the study. CPT 77048 is referenced in 19 tracked payer policy changes from Blue Cross Blue Shield of Vermont, Blue Cross Blue Shield of North Dakota, and 12 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 77048 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 77048 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 77048?

Aetna lists 77048 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 77048?

Anthem BCBS lists 77048 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 77048?

Arizona Complete Health lists 77048 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 77048?

BCBS Arizona lists 77048 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 77048?

BCBS Illinois lists 77048 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 77048?

There are 19 tracked policy changes affecting CPT 77048, 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 77048?

Payers that have issued tracked updates for CPT 77048 include: Blue Cross Blue Shield of Vermont, Blue Cross Blue Shield of North Dakota, Wisconsin Medicaid (ForwardHealth), Humana, Sentara Health Plans, Capital Blue Cross, HealthPartners, Premera Blue Cross, Blue Cross & Blue Shield of Mississippi, Texas Medicaid, Aetna, NY Medicaid, Blue Cross Blue Shield of Rhode Island, Indiana Medicaid (IHCP).

How do I get notified when CPT 77048 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 77048. 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 77048?

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 77048

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 77048 in one place.

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