Question 1

What insurance policy changes affect CPT 78804?

Accepted Answer

There are 3 tracked policy changes affecting CPT 78804, including updates from Highmark, Blue Cross Blue Shield of Rhode Island, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Question 2

Which payers have updated policy for CPT 78804?

Accepted Answer

Payers that have issued tracked updates for CPT 78804 include: Highmark, Blue Cross Blue Shield of Rhode Island, Blue Cross & Blue Shield of Mississippi.

Question 3

How do I get notified when CPT 78804 policy changes?

Accepted Answer

Create a free account at PolicyChanges.app and save a search filtered to CPT 78804. You will receive a daily digest email whenever a new policy change references this code.

Question 4

Why do payers change policies for CPT 78804?

Accepted Answer

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.

78804 Insurance Policy Changes

Prior Authorization Updates: Two Additions and 90+ Removals

Medical policy updates

Radioimmunoscintigraphy (Monoclonal Antibody Imaging) With Indium 111 Capromab Pendetide for Prostate Cancer