What insurance policy changes affect HCPCS D0364?

There are 3 tracked policy changes affecting HCPCS D0364, including updates from Connecticut Medicaid (HUSKY Health), Healthfirst. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS D0364?

Payers that have issued tracked updates for HCPCS D0364 include: Connecticut Medicaid (HUSKY Health), Healthfirst.

How do I get notified when HCPCS D0364 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS D0364. 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 D0364?

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.

PAYER POLICY CHANGES

D0364 Insurance Policy Changes

HCPCS D0364 is referenced in 3 tracked payer policy changes from Connecticut Medicaid (HUSKY Health) and Healthfirst. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS D0364 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Connecticut Medicaid (HUSKY Health) · Effective Oct 1, 2026High impact
2026.46 - Provider Bulletin - Updates to Dental Fee Schedules for Adults and Children - Revised
Effective for dates of service October 1, 2026 and forward, the Connecticut Medical Assistance Program updated the adult and child dental fee schedules. Coverage criteria changed for select CDT codes, including cone beam CT (D0364 through D0368), which requires prior authorization, and new codes were added for onlays, resin infiltration, rebase dentures, and alveoloplasty. D9947 (sleep dental device) was end-dated effective September 30, 2026, and based on American Dental Association guidance, several codes were revised, including D3120, D4240, D4241, D6241, D6545, D7260, D7283, D7285, D7660, D7770, D7771, D7870, D7950, and D7953.
Connecticut Medicaid (HUSKY Health) · Effective Oct 1, 2026High impact
2026.46 - Provider Bulletin - Updates to Dental Fee Schedules for Adults and Children
The adult and children dental fee schedules changed for dates of service October 1, 2026 and forward. Coverage criteria were modified for several CDT codes, including D0210 intraoral complete series (once every 3 years, age 9 and up) and cone beam CT codes D0364 through D0368 (once every 3 years, all ages, medically necessary to evaluate cysts, tumors or trauma). New CDT codes were added, including D2542 through D2544, D2642 through D2644, D2662 through D2664, D2982, D2990, D5710, D5711, D5720, D5721, D6110 through D6113, D6191, D6192 and D7321, and several codes were revised based on American Dental Association guidance, while CDT code D9947 was end-dated effective September 30, 2026.
Healthfirst · Effective Jul 1, 2025Medium impact
Healthfirst’s Medical, Dental, and Oral Health Coverage Reimbursement Policy
Healthfirst's Medical, Dental and Oral Health Coverage Reimbursement policy (PO-RE-169v2) covers dental services under the medical benefit when they are medically necessary and directly related to or integral to a covered medical service, such as reconstruction of the dental ridge after surgical removal of a tumor or stabilization of teeth in connection with a jaw fracture. Claims for these services must include a valid ICD-10-CM diagnosis code and a valid CDT procedure code, and the KX modifier is required effective July 1, 2025. The 4/20/2026 revision replaced CPT/HCPCS procedure code requirements with CDT procedure code requirements, and routine dental services remain excluded unless covered under the member's plan.

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2026.46 - Provider Bulletin - Updates to Dental Fee Schedules for Adults and Children - Revised

2026.46 - Provider Bulletin - Updates to Dental Fee Schedules for Adults and Children

Healthfirst’s Medical, Dental, and Oral Health Coverage Reimbursement Policy

What insurance policy changes affect HCPCS D0364?

Which payers have updated policy for HCPCS D0364?

How do I get notified when HCPCS D0364 policy changes?

Why do payers change policies for HCPCS D0364?