CPT 88375, in plain terms, covers A physician reads optical endomicroscopy images, either live during the scope or later from images sent over, and writes up the findings. Bill one unit for each endoscopic session. CPT 88375 is referenced in 5 tracked payer policy changes from Capital Blue Cross, Sentara Health Plans, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 88375 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 88375 on AAPC
Capital Blue Cross updated its medical policies, with most changes effective July 1, 2026 unless otherwise indicated. Prior authorization for Loargys and Exdensur now applies to J3590 and C9399 starting July 1, 2026, and the PA requirement for Exdensur moved from a 6/1 date to 7/1. Many revised medical injectable policies take effect August 1, 2026, and several policies remove procedure codes that will now be managed by EviCore.
Capital Blue Cross updated its medical policies with an effective date of March 1, 2026 unless otherwise indicated, and it delegated the medical specialty injectable policies to Prime Medical Pharmacy Solutions, which is making them more medication-specific for Commercial members with changed prior authorization periods for some drugs. Blenrep is a new policy, HCPCS code J9999 now requires prior authorization for it, and numerous injectables, including Botox, Opdivo SQ, Trastuzumab IV and Ocrevus IV, have revised policies effective 4/1/2026. Commercial knee brace codes L1834, L1840 and L1846 no longer require prior authorization because they are investigational, code 0707T now requires prior authorization under the Experimental and Investigational Procedures policy, and several Medicare Advantage medical policies were retired effective March 1, 2026.
Capital Blue Cross added preauthorization requirements for Keytruda Qlex (J9999) and Grafapex (J0614), and for new aflibercept, denosumab, IVIG and ustekinumab products under J3590, Q5157, J1599 and Q5137, with the changes effective March 1, 2026. Policy updates effective February 1, 2026 and March 1, 2026 also removed preauthorization for procedure code 48556 for commercial plans and for procedure codes 64596 and 64598 for commercial plans, and for procedure codes 64570 and L8681 for Medicare Advantage.
Sentara Health Plans' authorization updates effective October 1, 2025 archived several policies, including Deep Brain Stimulation (Surgical 74), Electric Bone Growth Stimulation (DME 09), Near-infrared Spectroscopy (Medical 330) and Home Spirometry (DME 23), with the stimulation policies moved into the new Electrical Stimulation policy (Medical 349). On October 1, 2025, prior authorization became required (Y) for 44 listed procedure codes and for codes including 0420U, 0421U, 0435U, 0212U, 0213U, 81500, 81503, 81528, 88230 and 89420, with some codes directed to OncoHealth or Avalon, and 97161 and 97162 require authorization with benefit limits. Earlier updates effective July 1 and August 1, 2025 removed authorization for codes including 98975, 98976, 98977, 98978, 98980 and 98981, and required authorization for Medicaid codes 0253U, 0254U and 0255U.
Use of confocal laser endomicroscopy is considered investigational under this policy. The policy describes two FDA-cleared systems, the Cellvizio probe-based system and the Pentax Confocal Video Colonoscope, and states that the Pentax device is no longer commercially available from the manufacturer. CPT 43206, 43252 and 88375 are listed under Investigational Codes. The Federal Employee Program may dictate that FDA-approved devices are not considered investigational and are assessed only on medical necessity.
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