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PAYER POLICY CHANGES

81105 Insurance Policy Changes

CPT 81105 is referenced in 1 tracked payer policy change from Regence BlueShield. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 81105 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Watch 81105

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REFERENCE DATA

Payers with rules11
Payers requiring prior auth11
  • BCBS Michigan · Effective October 13, 2026

    Prior authorization required in some cases

    BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

  • CountyCare Health Plan · Effective April 23, 2026

    Prior authorization required

    CountyCare Prior Authorization Look-Up Tool (All Codes)

  • Florida Blue · Effective March 27, 2026

    Prior authorization required

    Prior Authorization List: HMO – Marketplace Qualified Health Plans

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 81105?

Ambetter lists 81105 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 81105?

Arizona Complete Health lists 81105 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for 81105?

BCBS Michigan lists 81105 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 81105?

CalViva Health lists 81105 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 Carolina Complete Health require prior authorization for 81105?

Carolina Complete Health lists 81105 on Carolina Complete Health 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 81105?

There are 1 tracked policy change affecting CPT 81105, including updates from Regence BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 81105?

Payers that have issued tracked updates for CPT 81105 include: Regence BlueShield.

How do I get notified when CPT 81105 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 81105. 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 81105?

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 81105

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 81105 in one place.

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