Does CalViva Health require prior authorization for 77062?

CalViva Health lists 77062 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Community Health Plan of Imperial Valley require prior authorization for 77062?

Community Health Plan of Imperial Valley lists 77062 on Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect CPT 77062?

There are 14 tracked policy changes affecting CPT 77062, including updates from Blue Cross Blue Shield of Vermont, Wisconsin Medicaid (ForwardHealth), Humana. 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: Blue Cross Blue Shield of Vermont, Wisconsin Medicaid (ForwardHealth), Humana, BlueCross BlueShield of South Carolina, Florida Blue, Blue Cross & Blue Shield of Mississippi, Highmark, CareSource, Aetna, Premera Blue Cross.

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 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 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.

PAYER POLICY CHANGES

77062 Insurance Policy Changes

CPT 77062 is referenced in 14 tracked payer policy changes from Blue Cross Blue Shield of Vermont, Wisconsin Medicaid (ForwardHealth), and 8 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.

Blue Cross Blue Shield of Vermont · Effective Dec 1, 2026High impact
Preventive Care Reminder Sent to Members
Members receive the preventive services listed here at no cost when they align with USPSTF A- and B-rated services, ACIP vaccine recommendations, HRSA infant, child, adolescent and women's preventive guidelines, and Vermont state mandates. Covered procedure and diagnosis codes are listed for screenings, counseling, vaccines and preventive medications for children, adults and pregnant members, and some services require prior approval. Recent revisions add a Pre-Diabetes Preventive Interventions section for adults 18 and older, split mammography into diagnostic, ultrasound and MRI sections, and add pregnancy diagnosis codes effective 12/01/2026.
Wisconsin Medicaid (ForwardHealth) · Effective Jul 1, 2026High impact
Prior Authorization No Longer Required for Certain Advanced Breast Imaging Procedure Codes
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.
Humana · Effective Jul 1, 2026High impact
Breast Imaging - Medicare Advantage (Revised)
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.
BlueCross BlueShield of South Carolina · Effective May 29, 2026High impact
2026 May Medical Policy Updates
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.
BlueCross BlueShield of South Carolina · Effective May 29, 2026High impact
2026 May Medical Policy Updates
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.
Humana · Effective Jul 1, 2026Medium impact
Breast Imaging - Medicare Advantage (Revised)
This is a revised Medicare Advantage breast imaging coverage policy (effective 2026-07-01) that establishes medical necessity criteria for mammography, digital breast tomosynthesis, breast MRI, and ultrasound across Humana plans. The policy clarifies screening breast MRI eligibility based on genetic variants, family history, lifetime risk assessment (≥20%), male breast cancer history, or prior chest radiation. Billing teams must verify current applicability and confirm whether this practice's billing workflows align with the specified coverage criteria and applicable MAC jurisdictions.
BlueCross BlueShield of South Carolina · Effective May 29, 2026Medium impact
2026 May Medical Policy Updates
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.
Florida Blue · Effective Apr 1, 2026Medium impact
Accurate Documentation Optimizes Health Outcomes and More
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.
Blue Cross & Blue Shield of Mississippi · Effective Oct 1, 2025Medium impact
Digital Breast Tomosynthesis
Screening digital breast tomosynthesis (CPT 77063) is covered once per calendar year as an alternative to standard 2D mammography for women beginning at age 35, as part of the Healthy You! Wellness benefit, effective 01/01/2018. Digital breast tomosynthesis may be considered medically necessary as an alternative to standard 2D mammography for further imaging when used for breast cancer diagnostic purposes. Already effective 2025-10-01: ICD-10 diagnosis codes C50.A0, C50.A1 and C50.A2 for malignant neoplasm of breast were added to the code reference.
Highmark · Effective Sep 29, 2025Medium impact
Breast Cancer Awareness Month: Tips for Rescheduling Patients before January
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.
CareSource · Effective Jun 15, 2025Medium impact
[Ohio] Non-Covered Professional Radiology Services
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.
Aetna · Identified Oct 5, 2026Medium impact
Mammography (CPB 0584, reviewed 2026-09-10)
Annual screening mammography is medically necessary for women aged 40 and older as a preventive service, and for women under 40 who are judged to be at high risk, such as BRCA1 or BRCA2 mutation carriers. Diagnostic mammography is covered for members with signs or symptoms of breast disease or a history of breast cancer, whether or not they have preventive benefits. AI-based mammography, contrast-enhanced mammography for members who do not meet the medical necessity criteria, and screening mammography in men outside the listed indications are considered experimental, investigational or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Mammography (CPB 0584, reviewed 2025-09-09)
Aetna considers annual screening mammography medically necessary as a preventive service for women aged 40 and older, and for women under 40 who are judged to be at high risk, such as BRCA1 or BRCA2 mutation carriers and women meeting the other listed risk criteria. Diagnostic mammography is covered for members with signs or symptoms of breast disease or a history of breast cancer, regardless of whether the member has preventive benefits. Digital mammography and digital breast tomosynthesis are acceptable alternatives to film and standard 2D mammography, computer-aided detection is a medically necessary adjunct, and contrast-enhanced mammography is covered only for high-risk members who meet breast MRI criteria but have a documented contraindication, intolerance, or lack of access.
Premera Blue Cross · Identified Jun 18, 2026Medium impact
Medical Policy and Coding Updates - September 2019
Effective January 1, 2020, for individual plans only, subcutaneous implantable cardiac defibrillator code 33270, total ankle replacement codes 27702 and 27703, negative pressure wound therapy codes A6550, A7000 and E2402, and spinal orthosis codes such as L0450 and L0460 now require review for medical necessity and prior authorization, along with nerve block codes such as 64450 and 64490 and trigger point injection codes 20552 and 20553. Effective January 1, 2020, for individual plans only, many other codes including 92132, 77046 through 77049, 90460, 90461 and E0424 now require review for medical necessity. Effective September 1, 2019, hyoid myotomy code 21685 and denosumab code J0897 now require review for medical necessity and prior authorization, while lumbar discectomy codes 62287 and 62380 are reviewed for investigational status and no longer require prior authorization.

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Preventive Care Reminder Sent to Members

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 Imaging - Medicare Advantage (Revised)

2026 May Medical Policy Updates

Accurate Documentation Optimizes Health Outcomes and More

Digital Breast Tomosynthesis

Breast Cancer Awareness Month: Tips for Rescheduling Patients before January

[Ohio] Non-Covered Professional Radiology Services

Mammography (CPB 0584, reviewed 2026-09-10)

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

Medical Policy and Coding Updates - September 2019

Prior authorization required

Prior authorization required

Does CalViva Health require prior authorization for 77062?

Does Community Health Plan of Imperial Valley require prior authorization for 77062?

What insurance policy changes affect CPT 77062?

Which payers have updated policy for CPT 77062?

How do I get notified when CPT 77062 policy changes?

Why do payers change policies for CPT 77062?