What insurance policy changes affect CPT 19330?

There are 8 tracked policy changes affecting CPT 19330, including updates from Humana, Arkansas Blue Cross Blue Shield, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 19330?

Payers that have issued tracked updates for CPT 19330 include: Humana, Arkansas Blue Cross Blue Shield, Blue Cross & Blue Shield of Mississippi, Nevada Medicaid.

How do I get notified when CPT 19330 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 19330. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 19330?

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.

19330 — Surgical removal of a breast implant that has broken or leaked inside the body.: Insurance Policy Changes

19330 Insurance Policy Changes

CPT 19330, in plain terms, covers Surgical removal of a breast implant that has broken or leaked inside the body. CPT 19330 is referenced in 8 tracked payer policy changes from Humana, Arkansas Blue Cross Blue Shield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 19330 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Breast Reconstruction - Medicare Advantage (Revised)

Humana·Effective Aug 3, 2026

Humana Medicare Advantage has revised its breast reconstruction coverage policy (effective 08/03/2026) to clarify medical necessity criteria for reconstruction procedures following mastectomy, trauma, or congenital abnormalities. The policy applies MAC-specific Local Coverage Determinations (LCDs) by geographic jurisdiction and establishes criteria for determining coverage of implant removal, reduction mammaplasty, and related procedures. Billing teams must identify the appropriate MAC jurisdiction for each claim and apply the correct LCD requirements.

19330 Insurance Policy Changes

Breast Reconstruction - Medicare Advantage (Revised)

Payment Policy Material Amendment

Breast Procedures - MEDICAID - OKLAHOMA (Revised)

Breast Procedures - MEDICAID - FLORIDA (Revised)

Breast Procedures - MEDICAID - VIRGINIA (Revised)

Breast Procedures - MEDICAID - SOUTH CAROLINA (Revised)

Breast Reconstruction Following Mastectomy

Prior Authorization Requirement Updated for Procedure Code 19330