HCPCS Q4240 is officially defined as "Corecyte, for topical use only, per 0.5 cc." HCPCS Q4240 is referenced in 6 tracked payer policy changes from Sentara Health Plans, Independence Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS Q4240 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting January 1, 2027, Sentara Health Plans will require prior authorization for a long list of codes on Virginia commercial plans, including self-funded (ASO) plans, and for code 88380 on commercial, Medicaid and Medicare products, plus code 22860 on Medicare products. Sentara will also stop covering a separate list of codes on Virginia commercial and self-funded plans.
Independence Blue Cross published an update to its Medicare Advantage medical policy MA11.015ah on bioengineered skin substitutes on 2026-10-01, stating it became effective 10/01/2026, which is already in the past as of today. The lower extremity wound criteria, documentation and billing rules now directly follow CMS criteria, a Biobrane glove was added for second- and third-degree burns, and a long list of HCPCS codes was added as eligible while several CPT codes were marked experimental. Confirm with Independence Blue Cross that this is still the current version before relying on it.
Independence Blue Cross revised its Medicare Advantage medical policy MA11.015ah on bioengineered skin substitutes, effective 10/01/2026. The lower extremity wound criteria, documentation and billing rules now directly follow CMS criteria, a Biobrane glove was added for second- and third-degree burns, and a long list of HCPCS codes was added as eligible while several CPT codes were marked experimental. Because the effective date has already passed as of today, confirm with Independence Blue Cross that this is still the current version before relying on it.
Health Net California is updating prior authorization requirements effective December 1, 2025, removing PA requirements for many DME items, prosthetics, sleep studies, varicose vein treatments, and therapy services while maintaining PA requirements for non-emergency air transport, hysterectomies, and skin substitutes. These changes aim to reduce administrative burden and streamline approval processes.
Independence Blue Cross added a long list of CPT, HCPCS and unlisted codes to its experimental/investigational list under commercial policy 12.01.01bv, which means these services are not covered under the medical benefit, retroactive to October 1, 2026. It also removed some codes from that list because they are now considered eligible (52284, 55868 and a brain catheter placement code) and moved basivertebral nerve ablation and bioengineered skin substitutes to other IBX policies. The notice lists CPT 64999 both as added (for the Avance nerve graft) and removed (for stereotactic brain catheter placement), so confirm that code with IBX before billing it.
CMS is amending the Medicare Physician Fee Schedule Database (MPFSDB) payment files for the July 2026 update. The amendments apply to services furnished between January 1, 2026 and December 31, 2026, and they follow the 2026 MPFS Final Rule. The attached table adds codes such as the new code G0577, sets July 1, 2026 effective dates for many HCPCS and CPT code updates, and revises short descriptors, physician supervision indicators, and effective dates for other listed codes. This transmittal replaces Transmittal 13838, which was issued June 23, 2026, to correct an error in the attachment.
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