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PAYER POLICY CHANGES

88304 Insurance Policy Changes

CPT 88304, in plain terms, covers Level III surgical pathology with gross and microscopic exam for lower-complexity specimens such as a gallbladder or an appendix taken out for a reason other than incidental removal. CPT 88304 is referenced in 1 tracked payer policy change from New Jersey Medicaid. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 88304 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 88304 on AAPC

Watch 88304

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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 88304?

Anthem BCBS lists 88304 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 88304?

CalViva Health lists 88304 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 88304?

Community Health Plan of Imperial Valley lists 88304 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 88304?

There are 1 tracked policy change affecting CPT 88304, including updates from New Jersey Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 88304?

Payers that have issued tracked updates for CPT 88304 include: New Jersey Medicaid.

How do I get notified when CPT 88304 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 88304. 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 88304?

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 88304

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 88304 in one place.

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