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PAYER POLICY CHANGES

C9901 Insurance Policy Changes

HCPCS C9901 is officially defined as "Endoscopic defect closure within the entire gastrointestinal tract, including upper endoscopy (including diagnostic, if performed) or colonoscopy (including diagnostic, if performed), with all system and tissue anchoring components." HCPCS C9901 is referenced in 2 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS C9901 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

  • BCBS Michigan · Effective July 1, 2024

    Prior authorization required in some cases

    BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines)

FREQUENTLY ASKED QUESTIONS

Does BCBS Michigan require prior authorization for C9901?

BCBS Michigan lists C9901 on BCBSM and BCN procedure codes for which providers must request prior authorization (commercial lines) for commercial plans, with conditions (list dated October 13, 2026). Verify with the payer before scheduling.

Does Centene require prior authorization for C9901?

Centene lists C9901 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 C9901?

There are 2 tracked policy changes affecting HCPCS C9901, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS C9901?

Payers that have issued tracked updates for HCPCS C9901 include: Aetna.

How do I get notified when HCPCS C9901 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS C9901. 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 C9901?

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 C9901

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for C9901 in one place.

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