Does CountyCare Health Plan require prior authorization for S2325?

CountyCare Health Plan lists S2325 on CountyCare Prior Authorization Look-Up Tool (All Codes) for medicaid managed plans (list dated April 23, 2026). Verify with the payer before scheduling.

Does Fidelis Care require prior authorization for S2325?

Fidelis Care lists S2325 on Fidelis Care 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 S2325?

There are 3 tracked policy changes affecting HCPCS S2325, including updates from Sentara Health Plans, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS S2325?

Payers that have issued tracked updates for HCPCS S2325 include: Sentara Health Plans, Aetna.

How do I get notified when HCPCS S2325 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS S2325. 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 S2325?

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.

PAYER POLICY CHANGES

S2325 Insurance Policy Changes

HCPCS S2325 is officially defined as "Hip core decompression." HCPCS S2325 is referenced in 3 tracked payer policy changes from Sentara Health Plans and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS S2325 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Sentara Health Plans · Effective Feb 1, 2026Medium impact
Authorization Updates - Effective February 1, 2026
Effective February 1, 2026, Sentara Health Plans stopped requiring prior authorization or precertification for a long list of procedures and services for Medicare products and for Medicaid products offered in Virginia. The lists include breast reconstruction codes 19357, 19361 and 19364, glenohumeral arthrodesis codes 23800 and 23802, cranial neurostimulation codes 61885 and 61886, and MR elastography code 76391. The notice also lists ocular, ENT, cardiac, genetic testing and home management codes among those no longer requiring authorization.
Aetna · Identified Oct 25, 2026Medium impact
Core Decompression for Avascular Necrosis (CPB 0753, reviewed 2026-10-21)
Aetna's Clinical Policy Bulletin 0753 on core decompression for avascular necrosis lists a last review date of 10/21/2026, but the text does not describe what changed. Aetna considers core decompression medically necessary for early or pre-collapse (stage I or II) avascular necrosis of the hip, and considers it experimental, investigational or unproven for late or post-collapse (stage III or higher) hip avascular necrosis and for avascular necrosis of other joints. Aetna also considers several adjunctive treatments experimental, investigational or unproven for avascular necrosis of any joint, including bone marrow concentrate, platelet-rich plasma, bisphosphonates, bone morphogenic proteins and synthetic bone graft substitutes.
Aetna · Identified Aug 15, 2026Medium impact
Core Decompression for Avascular Necrosis (CPB 0753, reviewed 2025-10-30)
Aetna considers core decompression medically necessary for early or pre-collapse avascular necrosis of the hip, meaning stage I or II before X-ray changes are evident, and the presence of cysts is considered stage II under the Ficat classification. Core decompression is experimental, investigational or unproven for late or post-collapse hip disease (stage III or higher, when X-ray changes have occurred), for avascular necrosis of other joints such as the ankle, elbow, knee, mandibular condyle and shoulder, and for post-arthroscopic osteonecrosis. Adjunctive treatments for avascular necrosis of any joint, including bone morphogenic proteins, growth factors, mesenchymal stem cells, platelet-rich plasma, synthetic bone graft substitutes and biological augmentation with retro-drilling core decompression, are also listed as experimental, investigational or unproven.

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Authorization Updates - Effective February 1, 2026

Core Decompression for Avascular Necrosis (CPB 0753, reviewed 2026-10-21)

Core Decompression for Avascular Necrosis (CPB 0753, reviewed 2025-10-30)

Prior authorization required