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PAYER POLICY CHANGES

L5826 Insurance Policy Changes

HCPCS L5826 is officially defined as "Addition, endoskeletal knee-shin system, single axis, hydraulic swing phase control, with miniature high activity frame." HCPCS L5826 is referenced in 1 tracked payer policy change from Regence BlueShield. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS L5826 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 rules13
Payers requiring prior auth13
  • 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 Illinois · Effective October 1, 2026

    Prior authorization required in some cases

    Blue Cross Community Health Plans (Illinois Medicaid) Prior Authorization Code List

  • 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 L5826?

Ambetter lists L5826 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 L5826?

AmeriHealth Caritas lists L5826 on AmeriHealth Caritas Louisiana Act 233 prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for L5826?

Arizona Complete Health lists L5826 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does BCBS Illinois require prior authorization for L5826?

BCBS Illinois lists L5826 on Blue Cross Community Health Plans (Illinois Medicaid) Prior Authorization Code List for medicaid managed plans, with conditions (list dated October 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for L5826?

BCBS Michigan lists L5826 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.

What insurance policy changes affect HCPCS L5826?

There are 1 tracked policy change affecting HCPCS L5826, including updates from Regence BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS L5826?

Payers that have issued tracked updates for HCPCS L5826 include: Regence BlueShield.

How do I get notified when HCPCS L5826 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS L5826. 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 L5826?

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 L5826

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for L5826 in one place.

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