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PAYER POLICY CHANGES

98976 Insurance Policy Changes

CPT 98976 is referenced in 16 tracked payer policy changes from Independence Blue Cross, Pennsylvania Medicaid (DHS), and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 98976 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Watch 98976

Get one email when a payer policy names 98976, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

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REFERENCE DATA

Payers with rules3
Payers requiring prior auth3
  • Colorado Medicaid · Effective July 1, 2026

    Prior authorization required

    Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column)

  • Anthem BCBS · Effective February 11, 2026

    Prior authorization required

    List of items and services that require prior authorization (Elevance CMS-0057-F list)

  • Centene · Effective December 31, 2025

    Prior authorization required

    Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Anthem BCBS require prior authorization for 98976?

Anthem BCBS lists 98976 on List of items and services that require prior authorization (Elevance CMS-0057-F list) for medicaid managed plans (list dated February 11, 2026). Verify with the payer before scheduling.

Does Centene require prior authorization for 98976?

Centene lists 98976 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 Colorado Medicaid require prior authorization for 98976?

Colorado Medicaid lists 98976 on Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column) for medicaid ffs plans (list dated July 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect CPT 98976?

There are 16 tracked policy changes affecting CPT 98976, including updates from Independence Blue Cross, Pennsylvania Medicaid (DHS), Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 98976?

Payers that have issued tracked updates for CPT 98976 include: Independence Blue Cross, Pennsylvania Medicaid (DHS), Aetna, Blue Cross of Idaho, Medicare/CMS - Transmittals, Blue Cross & Blue Shield of Mississippi, Sentara Health Plans.

How do I get notified when CPT 98976 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 98976. 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 98976?

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 98976

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for 98976 in one place.

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