CPT 97755, in plain terms, covers Assessment of assistive technology needs with written recommendations, reported per 15 minutes. CPT 97755 is referenced in 4 tracked payer policy changes from Sentara Health Plans, CareSource, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 97755 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Official descriptor: CPT 97755 on AAPC
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
CareSource Georgia Medicaid is adding prior authorization requirements for skin substitutes, outpatient therapy codes, new Q1 2025 codes, and other outpatient services effective July 10, 2025. This affects a wide range of commonly used therapy and treatment codes that will require pre-approval before services can be rendered.
Aetna considers asfotase alfa (Strensiq) medically necessary for perinatal/infantile-onset and juvenile-onset hypophosphatasia (HPP) when the member has signs or symptoms of HPP, onset before 18 years of age, and a diagnosis confirmed either by a known pathogenic ALPL gene variant or by skeletal abnormalities on imaging with a below-range serum alkaline phosphatase level and an elevated TNSALP substrate level. The drug must be prescribed by or in consultation with an endocrinologist, geneticist, or physician specializing in the treatment of metabolic bone disorders, and continuation requires improvement from baseline on at least one listed measure; all other indications are considered experimental, investigational, or unproven.
BCBSAZ covers telehealth only as the member's benefit plan provides. Under the BlueCare Anywhere benefit, telehealth is covered when the Telehealth Services Administrator provides the service and determines the condition is appropriate, for a medical, therapy or psychiatry consultation. Under the in-network telehealth benefit, a service is covered when it would be covered in person and can be provided effectively by telehealth, through audio-visual services or limited audio-only services, and out-of-network non-emergency telehealth is not covered. The most recent review, dated 07/29/26, made no revisions.
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