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PAYER POLICY CHANGES

L1860 Insurance Policy Changes

HCPCS L1860 is officially defined as "Knee orthosis, modification of supracondylar prosthetic socket, custom fabricated (sk)." HCPCS L1860 is referenced in 1 tracked payer policy change from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS L1860 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 rules10
Payers requiring prior auth10
  • BCBS Michigan · Effective October 13, 2026

    Prior authorization required in some cases

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

  • BCBS Arizona · Effective October 1, 2026

    Prior authorization required

    AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Updated 10/01/2026)

  • Colorado Medicaid · Effective July 1, 2026

    Prior authorization required

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

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for L1860?

Ambetter lists L1860 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for L1860?

AmeriHealth Caritas lists L1860 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans, with conditions. Verify with the payer before scheduling.

Does BCBS Arizona require prior authorization for L1860?

BCBS Arizona lists L1860 on AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Updated 10/01/2026) for medicare advantage plans (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for L1860?

BCBS Michigan lists L1860 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 L1860?

CalViva Health lists L1860 on CalViva Health 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 L1860?

There are 1 tracked policy change affecting HCPCS L1860, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS L1860?

Payers that have issued tracked updates for HCPCS L1860 include: Aetna.

How do I get notified when HCPCS L1860 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS L1860. 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 L1860?

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 L1860

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for L1860 in one place.

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