C9745 Insurance Policy Changes

HCPCS C9745 is officially defined as "Nasal endoscopy, surgical; balloon dilation of eustachian tube." HCPCS C9745 is referenced in 4 tracked payer policy changes from Blue Cross Blue Shield of Rhode Island, Indiana Medicaid (IHCP), and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS C9745 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross Blue Shield of Rhode Island · Identified Jun 20, 2026Medium impact
July 2017
Already effective September 1, 2017, BCBSRI requires providers to report the name and Type 1 NPI of the ordering provider on the CMS-1500 claim or electronic submission for laboratory, imaging, durable medical equipment and home infusion services, and missing or incomplete information results in the claim being rejected back to the provider. Already effective January 1, 2017, CPT 62320, 62322, 62324 and 62326 changed from not medically necessary to medically necessary with prior authorization, and CPT 83861 is covered and separately reimbursed for commercial and BlueCHiP for Medicare products. Already effective September 1, 2017, CPT 92227 and 92228 are covered for BlueCHiP for Medicare only when filed by an optometrist or ophthalmologist, and CPT 92228 is not medically necessary for commercial products for other indications.
Indiana Medicaid (IHCP) · Identified Jun 19, 2026Medium impact
BT202158: IHCP updates Outpatient Fee Schedule
The IHCP reviewed the Outpatient Fee Schedule, found discrepancies, and will reflect the changes in the next regular update to that schedule. Codes listed twice on previous versions will appear only once, codes missing from the schedule are covered in the outpatient setting and can be billed for dates of service on or after the date listed for each code, and other listed codes are noncovered and will be added to the schedule. Codes that have been nationally end dated will be removed from the schedule, and Current Dental Terminology (CDT) codes cannot be billed on institutional claims (UB-04 claim form or electronic equivalent).
Premera Blue Cross · Identified Jun 18, 2026Medium impact
Medical Policy and Coding Updates - November 2020
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.
Premera Blue Cross · Identified Jun 18, 2026Medium impact
Medical Policy and Coding Updates - December 2020
Effective December 1, 2020, balloon dilation of the eustachian tube for chronic obstructive eustachian tube dysfunction changed from investigational to medically necessary for patients age 22 and older. Effective December 3, 2020, the Miscellaneous Oncology Drugs and VEGF inhibitor policies made HCPCS J9039, J2820 and J9308 subject to medical necessity and prior authorization review. Effective December 1, 2020, HCPCS J7333 for intra-articular hyaluronan injections for osteoarthritis became subject to medical necessity review, CPT 47382 and 50592 for microwave tumor ablation became subject to medical necessity and prior authorization review, and CPT 0441T, 64624 and 93701 became subject to investigative review.

Watch C9745

Get one email when a payer policy names C9745, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

REFERENCE DATA

Payers with rules1

Payers requiring prior auth1

FREQUENTLY ASKED QUESTIONS

Does AmeriHealth Caritas require prior authorization for C9745?

AmeriHealth Caritas lists C9745 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

What insurance policy changes affect HCPCS C9745?

There are 4 tracked policy changes affecting HCPCS C9745, including updates from Blue Cross Blue Shield of Rhode Island, Indiana Medicaid (IHCP), Premera Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS C9745?

Payers that have issued tracked updates for HCPCS C9745 include: Blue Cross Blue Shield of Rhode Island, Indiana Medicaid (IHCP), Premera Blue Cross.

How do I get notified when HCPCS C9745 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS C9745. 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 C9745?

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 C9745

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for C9745 in one place.

See every payer rule

All billing codes J3590 C9399 J3490 99215 99213 99202

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

July 2017

BT202158: IHCP updates Outpatient Fee Schedule

Medical Policy and Coding Updates - November 2020

Medical Policy and Coding Updates - December 2020

Does AmeriHealth Caritas require prior authorization for C9745?

What insurance policy changes affect HCPCS C9745?

Which payers have updated policy for HCPCS C9745?

How do I get notified when HCPCS C9745 policy changes?

Why do payers change policies for HCPCS C9745?