CPT 89257 is referenced in 10 tracked payer policy changes from Sentara Health Plans, Anthem BCBS, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 89257 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Effective September 1, 2026, Anthem will require precertification/prior authorization for 29 new medical codes including diagnostic tests, surgical procedures, and specialized treatments for MyCare Ohio FIDE (Fully Integrated Dual Eligible) members. Services performed without proper authorization may be denied payment.
Effective September 1, 2026, Anthem will require prior authorization for 25 new medical codes across multiple specialties for Medicare Advantage members in California. These include gastroenterology tests, drug assays, oncology procedures, neurostimulation devices, and various surgical procedures.
Effective September 1, 2026, Anthem will require prior authorization for 28 additional medical codes for Medicare Advantage members in Virginia, including gastroenterology tests, neurostimulation procedures, and fertility treatments. Services performed without obtaining required precertification may be denied for payment.
Effective September 1, 2026, Anthem Medicare Advantage plans will require precertification/prior authorization for 26 specific medical codes including gastroenterology tests, neurostimulation procedures, spinal decompressions, and various specialized treatments. Services performed without proper authorization may be denied payment.
Anthem Medicare Advantage plans in California will require prior authorization for 27 specific medical codes starting September 1, 2026. These codes cover specialized procedures including neurostimulation, oncology testing, gastric procedures, and fertility treatments.
Effective September 1, 2026, Anthem will require precertification/prior authorization for 25 new medical codes across multiple specialties including gastroenterology, oncology, neurosurgery, and fertility services for Medicare Advantage members in New York. Services performed without proper prior authorization may be denied payment.
Effective September 1, 2026, Anthem will require prior authorization for 24 new medical codes including gastroenterology tests, drug assays, neurostimulation procedures, and various surgical procedures for Medicare Advantage members in Ohio. Claims submitted without proper precertification may be denied payment.
Anthem Blue Cross and Blue Shield of Georgia is adding prior authorization requirements for 26 specific medical codes effective September 1, 2026, for Medicare Advantage members only. These codes span multiple specialties including gastroenterology, oncology, neurostimulation procedures, and various surgical interventions.
Healthfirst covers infertility and fertility preservation services based on the member's benefit plan, and coverage differs by line of business. Essential Plan and Qualified Health Plan members receive basic infertility treatment, including prescription drugs, and Medicaid Managed Care and HARP infertility benefits are limited to three treatment cycles per lifetime. Excluded services include in vitro fertilization, gamete and zygote intrafallopian transfer, donor ova and sperm costs, embryo cryopreservation, reversal of tubal ligation or vasectomy, and surrogacy costs.
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