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PAYER POLICY CHANGES

86294 Insurance Policy Changes

CPT 86294 is referenced in 2 tracked payer policy changes from Excellus BlueCross BlueShield 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 86294 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Watch 86294

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • Anthem BCBS · Effective September 1, 2026

    Prior authorization required in some cases

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

  • 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 Anthem BCBS require prior authorization for 86294?

Anthem BCBS lists 86294 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 CalViva Health require prior authorization for 86294?

CalViva Health lists 86294 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 86294?

Community Health Plan of Imperial Valley lists 86294 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 86294?

There are 2 tracked policy changes affecting CPT 86294, including updates from Excellus BlueCross BlueShield, 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 86294?

Payers that have issued tracked updates for CPT 86294 include: Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 86294 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 86294. 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 86294?

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 86294

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 86294 in one place.

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