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PAYER POLICY CHANGES

Q4304 Insurance Policy Changes

HCPCS Q4304 is officially defined as "Grafix plus, per square centimeter (add-on, list separately in addition to primary procedure)." HCPCS Q4304 is referenced in 2 tracked payer policy changes from Health Net. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS Q4304 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 rules12
Payers requiring prior auth12
  • Anthem BCBS · Effective November 1, 2026

    Prior authorization required

    Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)

  • Blue Shield of California · Effective November 1, 2026

    Prior authorization required

    Prior Authorization List for Blue Shield Medicare

  • 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)

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for Q4304?

Ambetter lists Q4304 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 Q4304?

AmeriHealth Caritas lists Q4304 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for Q4304?

Anthem BCBS lists Q4304 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does BCBS Michigan require prior authorization for Q4304?

BCBS Michigan lists Q4304 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 Blue Shield of California require prior authorization for Q4304?

Blue Shield of California lists Q4304 on Prior Authorization List for Blue Shield Medicare for medicare advantage plans (list dated November 1, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS Q4304?

There are 2 tracked policy changes affecting HCPCS Q4304, including updates from Health Net. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS Q4304?

Payers that have issued tracked updates for HCPCS Q4304 include: Health Net.

How do I get notified when HCPCS Q4304 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS Q4304. 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 Q4304?

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 Q4304

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for Q4304 in one place.

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