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PAYER POLICY CHANGES

78835 Insurance Policy Changes

CPT 78835, in plain terms, covers Add-on for quantitative measurement of radiopharmaceutical uptake in a single area, reported in addition to the primary nuclear localization study. CPT 78835 is referenced in 2 tracked payer policy changes from Blue Cross Blue Shield of North Dakota and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 78835 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 78835 on AAPC

Watch 78835

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REFERENCE DATA

Payers with rules2
Payers requiring prior auth2
  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

  • Community Health Plan of Imperial Valley · Effective December 31, 2025

    Prior authorization required

    Community Health Plan of Imperial Valley CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does CalViva Health require prior authorization for 78835?

CalViva Health lists 78835 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 78835?

Community Health Plan of Imperial Valley lists 78835 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 78835?

There are 2 tracked policy changes affecting CPT 78835, including updates from Blue Cross Blue Shield of North Dakota, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 78835?

Payers that have issued tracked updates for CPT 78835 include: Blue Cross Blue Shield of North Dakota, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 78835 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 78835. 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 78835?

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 78835

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 78835 in one place.

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