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PAYER POLICY CHANGES

C9164 Insurance Policy Changes

HCPCS C9164 is officially defined as "Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg)." HCPCS C9164 is referenced in 2 tracked payer policy changes from Premera Blue Cross. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS C9164 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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REFERENCE DATA

Payers with rules2
Payers requiring prior auth2
  • 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 AmeriHealth Caritas require prior authorization for C9164?

AmeriHealth Caritas lists C9164 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Centene require prior authorization for C9164?

Centene lists C9164 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.

What insurance policy changes affect HCPCS C9164?

There are 2 tracked policy changes affecting HCPCS C9164, including updates from Premera Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS C9164?

Payers that have issued tracked updates for HCPCS C9164 include: Premera Blue Cross.

How do I get notified when HCPCS C9164 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS C9164. 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 HCPCS C9164?

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 C9164

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for C9164 in one place.

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