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PAYER POLICY CHANGES

80504 Insurance Policy Changes

CPT 80504, in plain terms, covers Pathology clinical consultation of moderate complexity, or 21 to 40 minutes of total time on the date when time is used to pick the level. No tracked policy changes reference CPT 80504 yet. New payer updates are added daily, so check back soon or create a free alert to be notified the moment a change affects this code.

Official descriptor: CPT 80504 on AAPC

No policies yet

No tracked policy changes match this filter yet. New policies are added daily.

Watch 80504

Get one email when a payer policy names 80504, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

  • Centene · Effective December 31, 2025

    Prior authorization required

    Sunshine Health Title XIX, Title XXI, Managed Medical Assistance 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 80504?

CalViva Health lists 80504 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 Centene require prior authorization for 80504?

Centene lists 80504 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance 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 80504?

Community Health Plan of Imperial Valley lists 80504 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 80504?

No policy changes affecting CPT 80504 have been tracked yet. Check back as coverage expands.

Which payers have updated policy for CPT 80504?

No payer-specific updates have been tracked for CPT 80504 yet.

How do I get notified when CPT 80504 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 80504. 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 80504?

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.

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