HCPCS C2614 is officially defined as "Probe, percutaneous lumbar discectomy." HCPCS C2614 is referenced in 8 tracked payer policy changes from Anthem BCBS, Humana, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS C2614 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Effective January 1, 2027, Anthem Medicare Advantage plans in New York will require prior authorization for nine specific procedure and diagnostic test codes, including oncology assays, ultrasound therapy, and spinal/carotid procedures. Providers must submit precertification requests through Availity Essentials before service delivery to avoid claims processing delays.
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage plans in Ohio will require prior authorization for eight new procedure and laboratory test codes, including oncology diagnostics, autoimmune testing, ultrasound therapy, and spinal/vascular procedures. Billing teams must submit authorization requests through Availity before providing these services to avoid potential claim delays.
Effective January 1, 2027, Anthem Blue Cross and Blue Shield and HealthKeepers, Inc. (Medicare Advantage) in Virginia will require prior authorization for eight newly specified procedure and test codes, including oncology assays, diagnostic imaging, ultrasound therapy, and spinal procedures. Billing teams must submit authorization requests through Availity before providing these services to avoid claims processing delays.
Effective January 1, 2027, Anthem Blue Cross and Blue Shield Medicare Advantage in Georgia will require prior authorization for nine newly specified procedure and laboratory test codes, including oncology assays, ultrasound therapy, spinal procedures, and carotid device revisions. Billing teams must submit authorization requests through Availity Essentials before providing these services on or after the effective date to ensure timely claims processing and reimbursement.
Effective January 1, 2027, Anthem Blue Cross Medicare Advantage plans in California will require prior authorization for eight newly designated procedure and diagnostic codes, including oncology molecular tests, autoimmune diagnostics, ultrasound therapy, and spinal/vascular interventions. Billing teams must submit authorization requests through Availity before providing these services to avoid processing delays, though this change does not affect member benefits or cost-sharing.
Humana revised its Medicare Advantage Spinal Decompression Surgery coverage policy (HUM-1216-006), with an effective date of 11/02/2026 and an annual review dated 10/13/2026. The revision updates coverage criteria for discectomy, laminectomy/laminotomy/foraminectomy/foraminotomy, laminoplasty and corpectomy, adds coverage limitations excluding several percutaneous and laser discectomy techniques, annular closure, and AI/augmented-reality-guided decompression, and updates coding information including new 2026 codes 62330, 62331 and 63032.
Excellus added several new intradiscal procedures to the investigational policy statement in its 06/18/26 annual review. Intradiscal procedures listed in the policy, including annulo-nucleoplasty, intradiscal electrothermal annuloplasty (IDET or IDTA), intradiscal biacuplasty, hydrodiscectomy, and intradiscal injections, are considered investigational. This version is effective October 15, 2026, and every CPT and HCPCS code listed in the policy is marked (E/I) Experimental/Investigational.
Effective February 5, 2021, partial meniscectomy for a degenerative knee tear that does not result in functional impairment symptoms is considered not medically necessary, and routine preoperative upper GI endoscopy is considered not medically necessary for individuals scheduled for bariatric surgery unless they meet the clinical criteria. The same date lowered the artificial pancreas device system and hybrid closed loop insulin delivery system age to 6 and older and lowered the cochlear implant age for bilateral hearing loss to 9 months or older. Effective November 1, 2020, the Selective Estrogen Receptor Modulators and Down Regulators policy was added with brand drugs including Arimidex, Aromasin, Evista, Faslodex and Femara, and coding updates made HCPCS C1821 subject to investigative review, made CPT 33981, 33982, 33983 and HCPCS C1726 subject to medical necessity and prior authorization review, and made CPT 33990 through 33993 subject to investigative review.
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