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PAYER POLICY CHANGES

93505 Insurance Policy Changes

CPT 93505, in plain terms, covers Endomyocardial biopsy, taking small samples of heart muscle through a catheter-passed bioptome. CPT 93505 is referenced in 1 tracked payer policy change from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 93505 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 93505 on AAPC

Watch 93505

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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)

  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter Health of Delaware CMS-0057-F prior authorization requirements

  • Centene · Effective December 31, 2025

    Prior authorization required

    Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for 93505?

Ambetter lists 93505 on Ambetter Health of Delaware CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Centene require prior authorization for 93505?

Centene lists 93505 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance 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 93505?

CountyCare Health Plan lists 93505 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 93505?

There are 1 tracked policy change affecting CPT 93505, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 93505?

Payers that have issued tracked updates for CPT 93505 include: Aetna.

How do I get notified when CPT 93505 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 93505. 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 93505?

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 93505

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 93505 in one place.

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