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PAYER POLICY CHANGES

95866 Insurance Policy Changes

CPT 95866, in plain terms, covers A needle test measuring the electrical activity of the muscles on one side of the breathing muscle (diaphragm). CPT 95866 is referenced in 3 tracked payer policy changes from Aetna, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 95866 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Official descriptor: CPT 95866 on AAPC

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REFERENCE DATA

Payers with rules2
Payers requiring prior auth2
  • 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 95866?

CalViva Health lists 95866 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 95866?

Community Health Plan of Imperial Valley lists 95866 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.

What insurance policy changes affect CPT 95866?

There are 3 tracked policy changes affecting CPT 95866, including updates from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross of Idaho. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 95866?

Payers that have issued tracked updates for CPT 95866 include: Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross of Idaho.

How do I get notified when CPT 95866 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 95866. 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 95866?

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 95866

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 95866 in one place.

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