Question 1

What insurance policy changes affect CPT 97542?

Accepted Answer

There are 6 tracked policy changes affecting CPT 97542, including updates from Sentara Health Plans, Health Net, Texas Medicaid. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Question 2

Which payers have updated policy for CPT 97542?

Accepted Answer

Payers that have issued tracked updates for CPT 97542 include: Sentara Health Plans, Health Net, Texas Medicaid, Humana.

Question 3

How do I get notified when CPT 97542 policy changes?

Accepted Answer

Create a free account at PolicyChanges.app and save a search filtered to CPT 97542. You will receive a daily digest email whenever a new policy change references this code.

Question 4

Why do payers change policies for CPT 97542?

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.

97542 Insurance Policy Changes

Authorization Updates - Effective January 1, 2026

25-1000 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

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

Update to Seating Assessment Benefits Available April 1, 2026

Mobility Assistive Devices (Wheelchairs) - MEDICAID - VIRGINIA (Revised)

Mobility Assistive Devices (Wheelchairs) - MEDICAID - SOUTH CAROLINA (Revised)