Does CalViva Health require prior authorization for 82947?

CalViva Health lists 82947 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 82947?

Community Health Plan of Imperial Valley lists 82947 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 82947?

There are 15 tracked policy changes affecting CPT 82947, including updates from Blue Cross Blue Shield of Vermont, Harvard Pilgrim Health Care, Arkansas Blue Cross Blue Shield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

How do I get notified when CPT 82947 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 82947. 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 82947?

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.

PAYER POLICY CHANGES

82947 Insurance Policy Changes

Q: Which payers have updated policy for CPT 82947?

Payers that have issued tracked updates for CPT 82947 include: Blue Cross Blue Shield of Vermont, Harvard Pilgrim Health Care, Arkansas Blue Cross Blue Shield, Blue Cross NC, Indiana Medicaid (IHCP), Aetna.

CPT 82947 is referenced in 15 tracked payer policy changes from Blue Cross Blue Shield of Vermont, Harvard Pilgrim Health Care, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 82947 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross Blue Shield of Vermont · Effective Dec 1, 2026High impact
Preventive Care Reminder Sent to Members
Members receive the preventive services listed here at no cost when they align with USPSTF A- and B-rated services, ACIP vaccine recommendations, HRSA infant, child, adolescent and women's preventive guidelines, and Vermont state mandates. Covered procedure and diagnosis codes are listed for screenings, counseling, vaccines and preventive medications for children, adults and pregnant members, and some services require prior approval. Recent revisions add a Pre-Diabetes Preventive Interventions section for adults 18 and older, split mammography into diagnostic, ultrasound and MRI sections, and add pregnancy diagnosis codes effective 12/01/2026.
Harvard Pilgrim Health Care · Effective Nov 1, 2026High impact
Point32Health Payment Policy updates
Point32Health consolidated multiple legacy payment policies into new integrated policies effective November 1, 2026, affecting Evaluation and Management, DME/Medical Supplies, Rehabilitation/Long-Term Acute Care, and Skilled Nursing Facility services across Harvard Pilgrim and Tufts Health plans. The payer also removed specific CPT codes from several laboratory policies and clarified modifier usage (PO and PN) for outpatient facility billing.
Arkansas Blue Cross Blue Shield · Effective Nov 1, 2026High impact
Policy Criteria Change-Material Amendment
Arkansas Blue Cross revised coverage criteria for three laboratory testing policies effective 11/01/2026: (1) Nongenetic prenatal screening now covers only specific tests (blood type, Rh status, anemia, Group B strep, rubella, varicella immunity, and fetal fibronectin for preterm labor symptoms) with 40 procedure codes removed; (2) CRP/ESR inflammation testing expanded to cover 17 specific inflammatory conditions with defined frequency; (3) Alpha-1 antitrypsin testing removed 2 codes with no coverage criteria changes. Billing teams must identify and deny claims for removed codes and non-covered indications.
Blue Cross NC · Effective Feb 11, 2026High impact
Medical Policy Update February 11, 2026
Blue Cross NC updated multiple medical policies effective February 11, 2026, including changes to coverage criteria for STI testing, diabetes testing code additions, cervical cancer screening restrictions, and vaginitis testing limits. Several CPT codes were removed from covered services while new codes were added for specific conditions.
Harvard Pilgrim Health Care · Identified Sep 8, 2026High impact
Metabolic monitoring for patients on antipsychotic medications
Point32Health issued a metabolic monitoring policy for patients on antipsychotic medications, emphasizing annual screening for diabetes and cholesterol levels. The policy provides approved CPT codes for billing glucose, HbA1c, LDL-C, and other cholesterol tests, and requires providers to document baseline metabolic testing at discharge and coordinate care across behavioral health, primary care, and prescribing providers.
Harvard Pilgrim Health Care · Identified Jun 26, 2026High impact
Metabolic monitoring for patients on antipsychotic medications
Point32Health issued new guidance requiring annual metabolic monitoring (glucose, HbA1c, and cholesterol testing) for all patients on antipsychotic medications across all age groups. Billing teams must use specific approved CPT codes for these screenings and ensure proper documentation, especially for inpatient psychiatric discharges. This policy emphasizes care coordination among providers and includes a referral pathway for Tufts Health Together SMI members.
Indiana Medicaid (IHCP) · Effective Jan 1, 2026Medium impact
BT202624: IHCP corrects pricing for certain laboratory codes
IHCP (Indiana Medicaid) corrected pricing errors for three laboratory codes (82947, 82948, 87168) effective retroactively from January 1, 2026. Claims paid at incorrect rates will be automatically mass adjusted with reprocessed claims appearing on remittance advices starting March 25, 2026.
Aetna · Identified Oct 19, 2026Medium impact
Intermittent Intravenous Insulin Therapy (CPB 0742, reviewed 2026-10-16)
Aetna considers intermittent intravenous insulin therapy experimental, investigational, or unproven for diabetes mellitus and all other indications, and it considers insulin potentiation therapy experimental for arthritis, cancer, infectious diseases, and other conditions. CPT codes 82947, 82948, 82950, 84132, 84133, and 84540 are not covered when performed in the context of intermittent intravenous insulin therapy, and HCPCS code G9147 (outpatient intravenous insulin treatment) is not covered for the indications listed. The policy does not apply to insulin infusions used to treat diabetic ketoacidosis or hyperosmolar coma.
Aetna · Identified Sep 30, 2026Medium impact
Pancreas Transplantation Alone (PTA) and Islet Cell Transplantation (CPB 0601, reviewed 2026-09-18)
Aetna's Clinical Policy Bulletin 0601 covers pancreas transplantation alone (PTA) and islet cell transplantation for commercial medical plans, and precertification of Lantidra (donislecel-jujn) is required in applicable plan designs. PTA is medically necessary for members who meet the transplanting institution's selection criteria, or, absent those criteria, the general criteria (controlled HIV with CD4 count greater than 200 cells/mm3 for more than 6 months and undetectable viral load, creatinine clearance greater than 40 ml/min, ejection fraction greater than or equal to 40%, and no malignancy except non-melanomatous skin cancers or low-grade prostate cancer) and the disease criteria (labile insulin-dependent diabetes with recurrent, acute and severe metabolic complications, and consistent failure of insulin-based management shown by HbA1c greater than 8.0 despite aggressive conventional therapy). Islet cell allotransplantation with Lantidra is covered for members 18 years or older with type 1 diabetes who cannot approach target HbA1c because of repeated severe hypoglycemia despite intensive diabetes management, when it is used with concomitant immunosuppression, the member has not had a renal transplant, and no more than 3 infusions have been given, while PTA for increased longevity, PTA primarily for lifestyle reasons, ex-situ machine pancreas perfusion, and pancreatic islet xenotransplantation are considered experimental, investigational, or unproven.
Aetna · Identified Aug 27, 2026Medium impact
Marnetegragene Autotemcel (Kresladi) (CPB 1102, reviewed 13-2026-07)
Aetna has established a new clinical policy (CPB 1102) for Marnetegragene Autotemcel (Kresladi), a gene therapy for severe leukocyte adhesion deficiency-I (LAD-I) in pediatric patients ages 9 months to <10 years. This is a one-time, single-dose autologous stem cell therapy requiring mandatory precertification through National Medical Excellence (877-212-8811) and administration at an Aetna Institutes GCIT Designated Network. Billing teams must implement precertification workflows and ensure strict compliance with 16 specific approval criteria before claims can be submitted.
Aetna · Identified Aug 16, 2026Medium impact
Intermittent Intravenous Insulin Therapy (CPB 0742, reviewed 2025-11-26)
Aetna considers intermittent intravenous insulin therapy experimental, investigational, or unproven for diabetes mellitus and all other indications. This covers the therapy under its other names, including hepatic activation therapy, metabolic activation therapy, physiologic insulin re-sensitization (PIR) infusions, pulse insulin therapy, and the Trina Health artificial pancreas treatment. Aetna also considers insulin potentiation therapy experimental for arthritis, cancer, infectious diseases, and other conditions, and considers blood glucose, potassium, respiratory quotient, and urine urea nitrogen tests experimental when performed in the context of intermittent intravenous insulin therapy. The policy does not apply to insulin infusions for diabetic ketoacidosis or hyperosmolar coma.
Aetna · Identified Aug 14, 2026Medium impact
Smell and Taste Disorders: Diagnosis (CPB 0390, reviewed 2026-05-26)
Aetna's Clinical Policy Bulletin 0390 sets the coverage rules for diagnosing smell and taste disorders. Aetna considers the following medically necessary for members with unexplained olfactory dysfunction or gustatory dysfunction: biopsy of the olfactory mucosa, drug assays and chemical analyses, electroencephalography for members with a history of seizures, hematological tests, medical evaluation, nasal endoscopy, CT or MRI to rule out an intracranial or peripheral nerve abnormality, neurological, otolaryngological and psychiatric consultation, standard taste tests, and standardized olfactory tests such as the University of Pennsylvania Smell Identification Test or Sniffin' Sticks. An initial visit and a follow-up visit are considered medically necessary for smell and taste testing, and additional visits for testing are considered not medically necessary. Aetna considers cerebrospinal fluid SARS-CoV-2 antibody testing, electrogustometry, TAS2R38 gene genotyping, MRI for COVID-19 olfactory dysfunction, nasal nitric oxide measurement, olfactometry, olfactory and gustatory event potentials, PET, rhinomanometry, rhinometry, SPECT, and H. pylori tests experimental, investigational or unproven for diagnosing these disorders.
Aetna · Identified Aug 13, 2026Medium impact
Erectile Dysfunction and Peyronie's Disease (CPB 0007, reviewed 2026-07-29)
Aetna considers the diagnosis and treatment of erectile dysfunction medically necessary under the criteria in its policy, including self-administered injectable medications, the external penile vacuum pump as a physician-prescribed durable medical equipment alternative to other therapies, and implantable penile prostheses when the documented criteria are met. Surgical correction of Peyronie's disease, such as plaque excisions, venous graft patching, tunica plication or the Nesbit tuck, is medically necessary for members who have the condition for 12 or more months with significant morbidity and have failed conservative medical treatment. Many other treatments, including extracorporeal shock wave therapy and testosterone injection for Peyronie's disease and stem cell therapy for erectile dysfunction, are considered experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Eating Disorders (CPB 0511, reviewed 2026-08-04)
Aetna considers these services medically necessary for members with anorexia nervosa or bulimia nervosa: medical evaluation with history and physical examination, psychiatric or psychological consultation and testing, blood count and serum chemistry, albumin and prealbumin, liver function tests, electrocardiography, urinalysis, thyroid function testing (TSH), bone density measurement for evaluation of anorexic members, and LH, FSH and estradiol for women with amenorrhea or oligomenorrhea. Treatment considered medically necessary includes nutritional counseling, psychotherapy (such as cognitive behavioral therapy, dialectical behavior therapy, family-based, interpersonal and psychodynamic psychotherapy), and enteral nutrition as a last resort for the treatment of anorexia nervosa. Self-administered pharmacotherapies are managed under the pharmacy benefit. The policy lists CPT and HCPCS codes covered if selection criteria are met, and codes not covered for the indications listed. Aetna considers a long list of services experimental, investigational or unproven for anorexia nervosa, bulimia nervosa and binge-eating disorder, including brain imaging, EEG, routine screening of asymptomatic adolescents and adults for eating disorders, acupuncture, deep brain stimulation, electroconvulsive therapy, repetitive transcranial magnetic stimulation, cannabinoids, oxytocin and ghrelin agonists.
Aetna · Identified Aug 13, 2026Medium impact
Pancreas Transplantation Alone (PTA) and Islet Cell Transplantation (CPB 0601, reviewed 2025-09-10)
Aetna considers pancreas transplantation alone (PTA) without a kidney transplant medically necessary for members who meet the transplanting institution's selection criteria. Where there are no institution criteria, PTA is considered medically necessary when general criteria are met, including controlled HIV with CD4 count greater than 200 cells/mm3 for more than 6 months and undetectable HIV-1 RNA, ejection fraction greater than or equal to 40%, and creatinine clearance greater than 40 ml/min, and disease-specific criteria are met, including labile insulin-dependent diabetes with recurrent severe metabolic complications and consistent failure of insulin-based management with HbA1c greater than 8.0. Islet cell allotransplantation with donislecel-jujn (Lantidra) is considered medically necessary when its initial approval criteria are met, and precertification of Lantidra is required of all Aetna participating providers and members in applicable plan designs.

Watch 82947

Get one email when a payer policy names 82947, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

See every payer rule for 82947

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 82947 in one place.

See every payer rule

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

Preventive Care Reminder Sent to Members

Point32Health Payment Policy updates

Policy Criteria Change-Material Amendment

Medical Policy Update February 11, 2026

Metabolic monitoring for patients on antipsychotic medications

Metabolic monitoring for patients on antipsychotic medications

BT202624: IHCP corrects pricing for certain laboratory codes

Intermittent Intravenous Insulin Therapy (CPB 0742, reviewed 2026-10-16)

Pancreas Transplantation Alone (PTA) and Islet Cell Transplantation (CPB 0601, reviewed 2026-09-18)

Marnetegragene Autotemcel (Kresladi) (CPB 1102, reviewed 13-2026-07)

Intermittent Intravenous Insulin Therapy (CPB 0742, reviewed 2025-11-26)

Smell and Taste Disorders: Diagnosis (CPB 0390, reviewed 2026-05-26)

Erectile Dysfunction and Peyronie's Disease (CPB 0007, reviewed 2026-07-29)

Eating Disorders (CPB 0511, reviewed 2026-08-04)

Pancreas Transplantation Alone (PTA) and Islet Cell Transplantation (CPB 0601, reviewed 2025-09-10)

Prior authorization required