What insurance policy changes affect CPT 19342?

There are 10 tracked policy changes affecting CPT 19342, including updates from Arkansas Blue Cross Blue Shield, Blue Cross Blue Shield of Rhode Island, Humana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

How do I get notified when CPT 19342 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 19342. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 19342?

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.

19342 — Surgical insertion or replacement of a breast implant on one side of the chest.: Insurance Policy Changes

Q: Which payers have updated policy for CPT 19342?

Payers that have issued tracked updates for CPT 19342 include: Arkansas Blue Cross Blue Shield, Blue Cross Blue Shield of Rhode Island, Humana, Aetna, Blue Cross & Blue Shield of Mississippi.

19342 Insurance Policy Changes

CPT 19342, in plain terms, covers Surgical insertion or replacement of a breast implant on one side of the chest. CPT 19342 is referenced in 10 tracked payer policy changes from Arkansas Blue Cross Blue Shield, Blue Cross Blue Shield of Rhode Island, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 19342 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

Pectus Excavatum and Poland's Syndrome: Surgical Correction (CPB 0272, reviewed 2026-04-17)

Aetna·Effective Apr 17, 2026

Aetna updated its coverage policy (CPB 0272) for surgical correction of pectus excavatum and Poland's syndrome, effective April 17, 2026. The policy establishes specific medical necessity criteria including pectus index >3.25, documented functional deficits (cardiac compression or reduced lung capacity ≤80% TLC), and required diagnostic testing. Experimental procedures (Dynamic Compression System, magnetic mini-mover, vacuum bell) and cosmetic repairs are not covered. Billing teams must verify all criteria are met before processing claims for covered CPT codes 21740, 21742, 21743, and Poland's syndrome reconstruction codes.

19342 Insurance Policy Changes

Payment Policy Material Amendment

Medical policy updates

Breast Surgery - MEDICAID - LOUISIANA (Revised)

Pectus Excavatum and Poland's Syndrome: Surgical Correction (CPB 0272, reviewed 2026-04-17)

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

Augmentation Mammoplasty