Question 1

What insurance policy changes affect CPT 97167?

Accepted Answer

There are 3 tracked policy changes affecting CPT 97167, including updates from Texas Medicaid, Nevada Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Question 2

Which payers have updated policy for CPT 97167?

Accepted Answer

Payers that have issued tracked updates for CPT 97167 include: Texas Medicaid, Nevada Medicaid.

Question 3

How do I get notified when CPT 97167 policy changes?

Accepted Answer

Create a free account at PolicyChanges.app and save a search filtered to CPT 97167. You will receive a daily digest email whenever a new policy change references this code.

Question 4

Why do payers change policies for CPT 97167?

Accepted Answer

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.

97167 Insurance Policy Changes

Update to Seating Assessment Benefits for the CSHCN Services Program Effective May 1, 2026

Update to Seating Assessment Benefits Available April 1, 2026

Attention Provider Type 60 (School Health Services): Ordering, Prescribing and Referring Requirements Updated