What insurance policy changes affect CPT 96367?

There are 9 tracked policy changes affecting CPT 96367, including updates from Aetna, 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 96367?

Payers that have issued tracked updates for CPT 96367 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when CPT 96367 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 96367. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 96367?

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.

96367 — An additional IV infusion given after the first one for treatment, prevention, or diagnosis purposes.: Insurance Policy Changes

96367 Insurance Policy Changes

CPT 96367, in plain terms, covers An additional IV infusion given after the first one for treatment, prevention, or diagnosis purposes. CPT 96367 is referenced in 9 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 96367 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

Elivaldogene Autotemcel (Skysona) (CPB 1017, reviewed 2026-04-08)

Aetna·Effective Apr 8, 2026

Aetna has issued a new Clinical Policy Bulletin (CPB 1017, effective 2026-04-08) establishing coverage criteria for Skysona (elivaldogene autotemcel), a gene therapy for early active cerebral adrenoleukodystrophy (CALD) in boys ages 4-17. This is a specialized therapy requiring precertification, administration at designated Aetna Institutes GCIT Network facilities, and compliance with strict clinical and laboratory eligibility criteria. Billing teams must implement precertification requirements and ensure only qualifying patients are billed for this high-cost therapy.

96367 Insurance Policy Changes

Efgartigimod Alfa-fcab (Vyvgart) and Efgartigimod Alfa and Hyaluronidase-qvfc (Vyvgart Hytrulo) (CPB 1002, reviewed 2026-08-11)

Carfilzomib (Kyprolis) (CPB 0845, reviewed 2026-03-02)

Panitumumab (Vectibix) (CPB 0748, reviewed 2025-12-23)

Elivaldogene Autotemcel (Skysona) (CPB 1017, reviewed 2026-04-08)

Plasminogen, Human-tvmh (Ryplazim) (CPB 0976, reviewed 2026-02-17)

Betibeglogene Autotemcel (Zynteglo) (CPB 1016, reviewed 2025-12-31)

Caplacizumab-yhdp (Cablivi) (CPB 0949, reviewed 2025-12-03)

Brexanolone (Zulresso) (CPB 0951, reviewed 2026-02-13)

Physiologic Insulin Resensitization (PIR)