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PAYER POLICY CHANGES

88240 Insurance Policy Changes

CPT 88240 is referenced in 2 tracked payer policy changes from Capital Blue Cross and Texas Medicaid. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 88240 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 rules9
Payers requiring prior auth9
  • 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)

  • Anthem BCBS · Effective September 1, 2026

    Prior authorization required in some cases

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

  • CountyCare Health Plan · Effective April 23, 2026

    Prior authorization required

    CountyCare Prior Authorization Look-Up Tool (All Codes)

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 88240?

Ambetter lists 88240 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 Anthem BCBS require prior authorization for 88240?

Anthem BCBS lists 88240 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 BCBS Michigan require prior authorization for 88240?

BCBS Michigan lists 88240 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 88240?

CalViva Health lists 88240 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 88240?

Carolina Complete Health lists 88240 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 88240?

There are 2 tracked policy changes affecting CPT 88240, including updates from Capital Blue Cross, Texas Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 88240?

Payers that have issued tracked updates for CPT 88240 include: Capital Blue Cross, Texas Medicaid.

How do I get notified when CPT 88240 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 88240. 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 88240?

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 88240

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 88240 in one place.

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