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PAYER POLICY CHANGES

81267 Insurance Policy Changes

CPT 81267 is referenced in 3 tracked payer policy changes from Humana. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 81267 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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REFERENCE DATA

Payers with rules10
Payers requiring prior auth10
  • 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)

  • Excellus BlueCross BlueShield · Effective October 1, 2026

    Prior authorization required

    Excellus BCBS utilization management standard clinical review preauthorization list

  • Anthem BCBS · Effective September 1, 2026

    Prior authorization required in some cases

    Virginia Local Precertification/Prior Authorization List (HMO & EPO)

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 81267?

Ambetter lists 81267 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 AmeriHealth Caritas require prior authorization for 81267?

AmeriHealth Caritas lists 81267 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for 81267?

Anthem BCBS lists 81267 on Virginia Local Precertification/Prior Authorization List (HMO & EPO) for commercial plans, with conditions (list dated September 1, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for 81267?

Arizona Complete Health lists 81267 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 81267?

BCBS Michigan lists 81267 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.

What insurance policy changes affect CPT 81267?

There are 3 tracked policy changes affecting CPT 81267, including updates from Humana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 81267?

Payers that have issued tracked updates for CPT 81267 include: Humana.

How do I get notified when CPT 81267 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 81267. 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 81267?

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 81267

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 81267 in one place.

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