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PAYER POLICY CHANGES

93261 Insurance Policy Changes

CPT 93261, in plain terms, covers Physician performs in-person interrogation of a subcutaneous implantable defibrillator system with analysis and written report. CPT 93261 is referenced in 4 tracked payer policy changes from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 93261 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 93261 on AAPC

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • CountyCare Health Plan · Effective April 23, 2026

    Prior authorization required in some cases

    CountyCare Prior Authorization Look-Up Tool (All Codes)

  • 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 CalViva Health require prior authorization for 93261?

CalViva Health lists 93261 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 93261?

Community Health Plan of Imperial Valley lists 93261 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.

Does CountyCare Health Plan require prior authorization for 93261?

CountyCare Health Plan lists 93261 on CountyCare Prior Authorization Look-Up Tool (All Codes) for medicaid managed plans, with conditions (list dated April 23, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 93261?

There are 4 tracked policy changes affecting CPT 93261, including updates from Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Premera Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 93261?

Payers that have issued tracked updates for CPT 93261 include: Blue Cross & Blue Shield of Mississippi, Excellus BlueCross BlueShield, Premera Blue Cross, Aetna.

How do I get notified when CPT 93261 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 93261. 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 93261?

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 93261

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 93261 in one place.

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