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PAYER POLICY CHANGES

C9738 Insurance Policy Changes

HCPCS C9738 is officially defined as "Adjunctive blue light cystoscopy with fluorescent imaging agent (list separately in addition to code for primary procedure)." HCPCS C9738 is referenced in 1 tracked payer policy change from Blue Shield of California. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS C9738 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

  • Coordinated Care · Effective December 31, 2025

    Prior authorization required

    Coordinated Care CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Centene require prior authorization for C9738?

Centene lists C9738 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 Coordinated Care require prior authorization for C9738?

Coordinated Care lists C9738 on Coordinated Care 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 C9738?

There are 1 tracked policy change affecting HCPCS C9738, including updates from Blue Shield of California. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS C9738?

Payers that have issued tracked updates for HCPCS C9738 include: Blue Shield of California.

How do I get notified when HCPCS C9738 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS C9738. 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 C9738?

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 C9738

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for C9738 in one place.

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