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PAYER POLICY CHANGES

93597 Insurance Policy Changes

CPT 93597, in plain terms, covers Combined right and left heart catheterization for a congenital heart defect in a patient whose native heart and vessel connections are abnormal. No tracked policy changes reference CPT 93597 yet. New payer updates are added daily, so check back soon or create a free alert to be notified the moment a change affects this code.

Official descriptor: CPT 93597 on AAPC

No policies yet

No tracked policy changes match this filter yet. New policies are added daily.

Watch 93597

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REFERENCE DATA

Payers with rules5
Payers requiring prior auth5
  • Aetna · Effective November 1, 2026

    Prior authorization required

    Participating provider precertification list for Aetna

  • 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

FREQUENTLY ASKED QUESTIONS

Does Aetna require prior authorization for 93597?

Aetna lists 93597 on Participating provider precertification list for Aetna for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for 93597?

CalViva Health lists 93597 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 Centene require prior authorization for 93597?

Centene lists 93597 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 Community Health Plan of Imperial Valley require prior authorization for 93597?

Community Health Plan of Imperial Valley lists 93597 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 93597?

CountyCare Health Plan lists 93597 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 93597?

No policy changes affecting CPT 93597 have been tracked yet. Check back as coverage expands.

Which payers have updated policy for CPT 93597?

No payer-specific updates have been tracked for CPT 93597 yet.

How do I get notified when CPT 93597 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 93597. 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 93597?

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 93597

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 93597 in one place.

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RELATED

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