HCPCS G0680 is officially defined as "Detection and quantification of coronary artery calcium and/or aortic valve calcification from algorithmic analysis of computed tomography of the chest with report." HCPCS G0680 is referenced in 14 tracked payer policy changes from Health Net, Blue Cross Blue Shield of Rhode Island, and 7 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS G0680 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Community Health Plan of Imperial Valley updated prior authorization requirements with immediate changes for incontinence supplies (PA only required beyond 186 units/month or $165/month limit) and extensive new PA requirements effective April 1, 2026 for multiple categories including advanced imaging, genetic testing, pharmaceuticals, and skin substitutes.
Health Net has updated prior authorization requirements with immediate changes to Medi-Cal incontinence supplies (PA only required beyond 186 units/month or $165/month limit) and new PA requirements for multiple services including advanced imaging, genetic testing, neuro stimulators, medications, and orthotics effective April 1, 2026.
Blue Cross Blue Shield of Rhode Island updated HCPCS Level II code coverage and payment rules effective April 1, 2026. Multiple codes have new coverage designations including newly covered codes, non-covered codes, medical review requirements, and pharmacy benefit changes.
Independence Blue Cross updated its Experimental/Investigational Services policy (MA00.005as to MA00.005at) effective 04/01/2026, adding 7 new codes (CPT 0614U, 0615U; HCPCS A8005, A8006, C1743, C8010, G0680) and 3 unlisted code categories to the non-covered list, while removing 6 codes that are now addressed in separate medical policies or have changed coverage status. Billing teams must immediately identify and deny claims for the newly added codes and services.
Independence Blue Cross updated policy 12.01.01bt (now superseded by 12.01.01bu) to reclassify experimental/investigational services effective 04/01/2026. The update adds 12 new HCPCS codes and 2 new CPT codes to the non-covered experimental list, removes 8 CPT codes and 1 HCPCS code that are now covered or addressed in separate policies, and adds unlisted code services (autologous tissue harvesting, hematopoietic cells, and remote monitoring systems) as experimental/investigational. Billing teams must immediately update systems to reflect these code changes to prevent claim denials.
Blue Cross Blue Shield of Michigan has implemented its Q1 2026 HCPCS code updates, adding 56 new codes and deleting 6 codes effective April 1, 2026. Most new skin substitute codes (A2040-A2045, Q4418-Q4440) are not covered, while new drug/injection codes (J-codes) and COVID-19 related codes are generally covered.
Texas Medicaid is implementing first quarter 2026 HCPCS updates effective April 1, 2026, adding new covered and non-covered procedure codes with specific age limitations and prior authorization requirements. Several existing codes are being discontinued with direct replacements required.
Texas Medicaid CSHCN Services Program is implementing Q1 2026 HCPCS updates effective April 1, 2026. Multiple codes are being added as benefits (pending rate hearings), added as non-covered, or discontinued entirely. Several new codes require prior authorization and have age restrictions.
The policy history dates the latest update 11/01/2026. Coronary artery calcium scoring may be considered medically necessary once every 5 years when either of two conditions is met: it is an adjunct to standard cardiovascular risk assessment in asymptomatic adults without known coronary artery disease, or the individual has clinical atherosclerotic cardiovascular disease, is at least 40 years of age, has borderline to intermediate 10-year ASCVD risk, and is not currently on lipid-lowering therapy. AI-based automated detection, quantification or scoring of coronary artery calcium on chest CT is investigational, and the use of CT to detect coronary artery calcification is investigational for all other indications.
Blue Cross Blue Shield of Massachusetts medical policy changes carry effective dates of May 1, 2026, July 1, 2026, August 1, 2026 and September 19, 2026, all of which have now passed. Key changes include new prior authorization for Tyruko under Medicare Advantage Part B, prior authorization and step therapy updates across several commercial drug policies, and a move of brand Hetlioz and brand Aubagio to non-formulary, non-covered status in favor of generic tasimelteon and teriflunomide. Imaging, sleep, genetic testing and radiation therapy guidelines were also revised, and HCPCS code G0680 was added as investigational.
Premera Washington policy changes carry effective dates from April 1, 2026 through July 2, 2026, and all of those dates had passed as of 2026-11-05. Many listed codes now require review for medical necessity and prior authorization, and several services now require review for site of service, including Upper Gastrointestinal Endoscopy, Carpal Tunnel Release Surgical Treatments, and Shoulder Arthroscopy in Adults. Other changes mark specific procedures as investigational or not medically necessary, add or remove criteria for drugs, and add quantity limits for some medications.
CalViva Health updated prior authorization requirements effective immediately for incontinence supplies (PA only required beyond 186 units/month or $165 benefit limit) and added PA requirements for multiple new services including genetic testing, advanced imaging for under 21, and various pharmaceuticals effective April 1, 2026.
The Indiana Health Coverage Programs (IHCP) set coverage and billing information for procedure codes added in the April 2026 quarterly HCPCS update, effective for dates of service on or after April 1, 2026. Codes marked noncovered are not covered for any IHCP program. Pricing for the new codes depends on CMS fee schedules that were still awaiting final posting, and claims submitted before pricing is entered into the claim-processing system may initially be denied.
The Indiana Health Coverage Programs (IHCP) set coverage and billing information for procedure codes in the April 2026 quarterly HCPCS update, effective for dates of service on or after April 1, 2026. This bulletin replaces the originally published update in IHCP Bulletin BT202649, and it sets prior authorization criteria for J3404, J9183, and the Q5161 and Q5162 biosimilars. Codes discontinued effective March 31, 2026 have no alternative codes identified by the IHCP, and codes marked allowed for podiatrists (provider specialty 140) are limited to that provider specialty.
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