What insurance policy changes affect CPT 77062?

There are 11 tracked policy changes affecting CPT 77062, including updates from Humana, Wisconsin Medicaid (ForwardHealth), BlueCross BlueShield of South Carolina. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 77062?

Payers that have issued tracked updates for CPT 77062 include: Humana, Wisconsin Medicaid (ForwardHealth), BlueCross BlueShield of South Carolina, Aetna, Florida Blue, Highmark, CareSource.

How do I get notified when CPT 77062 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 77062. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 77062?

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.

77062 Insurance Policy Changes

CPT 77062 is referenced in 11 tracked payer policy changes from Humana, Wisconsin Medicaid (ForwardHealth), and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 77062 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact
Breast Imaging - Medicare Advantage (Revised)
Humana·Effective Jul 1, 2026
This is a comprehensive Medicare Advantage breast imaging policy (effective 07/01/2026) that establishes coverage criteria for mammography, digital breast tomosynthesis, breast MRI, and ultrasound. The policy clarifies medical necessity standards across different imaging modalities and specifies screening breast MRI eligibility based on genetic variants, familial risk, lifetime risk calculations (≥20%), male breast cancer history, or prior chest radiation. Billing teams must apply jurisdiction-specific LCDs where applicable or use the referenced criteria for consistent coverage determination.
High impact
Prior Authorization No Longer Required for Certain Advanced Breast Imaging Procedure Codes
Wisconsin Medicaid (ForwardHealth)·Effective Jul 1, 2026
Effective July 1, 2026, Wisconsin Medicaid no longer requires prior authorization for the first instance of advanced breast imaging procedures (MRI and digital tomosynthesis) within a 12-month period for members with increased breast cancer risk or dense breast tissue. Providers must append modifier UA to specific CPT codes and submit claims directly without PA requests for qualifying cases; PA is still required for any subsequent imaging within the same 12-month period.
High impact
Breast Imaging - Medicare Advantage (Revised)
Humana·Effective Jul 1, 2026
This is a revised Medicare Advantage policy for breast imaging (effective 07/01/2026) that establishes coverage criteria for mammography, digital breast tomosynthesis, breast MRI, and ultrasound. The policy clarifies medical necessity requirements and references applicable Local Coverage Determinations (LCDs) by MAC jurisdiction. Billing teams must verify which MAC jurisdiction applies to their geographic location to determine specific coverage rules.
High impact
2026 May Medical Policy Updates
BlueCross BlueShield of South Carolina·Effective May 29, 2026
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released 40 updated medical policies effective May 29, 2026. Most are routine annual reviews with no policy intent changes. Key billing updates include: new CPT codes 77062-77063 for breast cancer screening, replacement of CPT 99401-99402 with HCPCS S9943 for breastfeeding counseling, new compression pump CPT codes E0658/E0678-E0683 for lymphedema treatment, new CPT 0423U for pharmacogenetic testing, addition of HDR prostate brachytherapy as salvage therapy, new corneal collagen cross-linking products covered, and deletion of radiation therapy codes G6015-G6016.
High impact
2026 May Medical Policy Updates
BlueCross BlueShield of South Carolina·Effective May 29, 2026
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan released 40 medical policy updates effective May 29, 2026. Key billing changes include: (1) CPT codes 77062 and 77063 added for breast cancer screening; (2) HCPCS code S9943 replaces CPT codes 99401/99402 for breastfeeding counseling; (3) Seven new E-series codes (E0658, E0678-E0683) added for compression pumps; (4) CPT code 0423U added for pharmacogenetic testing; (5) One new policy (CAM 404) for Transcranial Magnetic Stimulation; (6) CAM 80133 expanded to include HDR temporary prostate brachytherapy as salvage therapy; (7) CAM 80160 reorganized criteria for ECMO; (8) CAM 90328 expanded to include epithelium-on corneal collagen products.
High impact
Breast Biopsy Procedures (CPB 0269, reviewed 2026-05-14)
Aetna·Effective May 14, 2026
Aetna's updated breast biopsy policy (CPB 0269, effective 2026-05-14) clarifies coverage for minimally invasive image-guided breast biopsy procedures as medically necessary alternatives when BI-RADS category 4 or 5 lesions are detected. The policy also explicitly designates several newer technologies (pegulicianine fluorescence, magnetic seeds, SAVI SCOUT, MarginProbe) as experimental/investigational and NOT covered. Billing teams must ensure claims for covered biopsy codes (19081-19086, 19283-19288) meet BI-RADS criteria, and reject claims for non-covered experimental procedures.
High impact
Mammography (CPB 0584, reviewed 2025-09-09)
Aetna·Effective Sep 9, 2025
Aetna has updated its mammography coverage policy (CPB 0584, effective 2025-09-09) to clarify covered and non-covered indications, including expanded coverage for transfeminine persons (40+ with 5+ years hormone use) and BRCA-positive men with gynecomastia. The policy explicitly classifies AI-based mammography, contrast-enhanced mammography (CEM), and low-dose CT combined mammography as experimental/investigational and not covered. Billing teams must ensure claims align with the specific medical necessity criteria outlined.
Medium impact
2026 May Medical Policy Updates
BlueCross BlueShield of South Carolina·Effective May 29, 2026
BlueCross BlueShield of South Carolina updated 35 medical policies in May 2026, with key billing code changes for breast cancer screening and breastfeeding counseling, expanded coverage for lymphedema compression pumps, new salvage therapy coverage for prostate cancer, and introduction of a new Transcranial Magnetic Stimulation policy.
Medium impact
Accurate Documentation Optimizes Health Outcomes and More
Florida Blue·Effective Apr 1, 2026
Florida Blue emphasizes the importance of accurate documentation using specific CPT II and ICD-10 codes for HEDIS quality measures including statin therapy, diabetic eye exams, cancer screenings, and flu vaccinations. This policy focuses on proper coding and documentation practices to improve patient outcomes and HEDIS scores.
Medium impact
Breast Cancer Awareness Month: Tips for Rescheduling Patients before January
Highmark·Effective Sep 29, 2025
This is a provider outreach bulletin from Highmark encouraging practices to reschedule patients who missed breast cancer screening appointments during October (Breast Cancer Awareness Month) to close HEDIS BCS-E measure gaps. The policy identifies specific mammogram CPT codes and mastectomy codes that count toward the screening measure for members ages 50-74, with measurement period Oct 1, 2023 through Dec 31, 2025.
Medium impact
[Ohio] Non-Covered Professional Radiology Services
CareSource·Effective Jun 15, 2025
CareSource Ohio Medicaid is implementing new claims editing logic effective June 15, 2025, to deny six professional radiology service codes that are now classified as non-covered services per Ohio Department of Medicaid guidelines. Billing teams must identify and stop billing these codes or face automatic claim denials.

All billing codes J3590 99213 99214 99212 99202 99203

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Breast Imaging - Medicare Advantage (Revised)

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

Breast Imaging - Medicare Advantage (Revised)

2026 May Medical Policy Updates

2026 May Medical Policy Updates

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

Mammography (CPB 0584, reviewed 2025-09-09)

2026 May Medical Policy Updates

Accurate Documentation Optimizes Health Outcomes and More

Breast Cancer Awareness Month: Tips for Rescheduling Patients before January

[Ohio] Non-Covered Professional Radiology Services