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PAYER POLICY CHANGES

E0716 Insurance Policy Changes

HCPCS E0716 is officially defined as "Supplies and accessories for intravaginal device intended to strengthen pelvic floor muscles during kegel exercises." HCPCS E0716 is referenced in 3 tracked payer policy changes from Medicare/CMS - Transmittals, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS E0716 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 rules6
Payers requiring prior auth6
  • Colorado Medicaid · Effective July 1, 2026

    Prior authorization required

    Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column)

  • CalViva Health · Effective December 31, 2025

    Prior authorization required

    CalViva Health CMS-0057-F prior authorization requirements

  • 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 E0716?

AmeriHealth Caritas lists E0716 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for E0716?

BCBS Michigan lists E0716 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 CalViva Health require prior authorization for E0716?

CalViva Health lists E0716 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Centene require prior authorization for E0716?

Centene lists E0716 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 Colorado Medicaid require prior authorization for E0716?

Colorado Medicaid lists E0716 on Colorado Health First Colorado Fee Schedule (Prior Authorization Needed column) for medicaid ffs plans (list dated July 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS E0716?

There are 3 tracked policy changes affecting HCPCS E0716, including updates from Medicare/CMS - Transmittals, Aetna, Premera Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS E0716?

Payers that have issued tracked updates for HCPCS E0716 include: Medicare/CMS - Transmittals, Aetna, Premera Blue Cross.

How do I get notified when HCPCS E0716 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS E0716. 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 E0716?

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 E0716

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for E0716 in one place.

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