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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

October 2017

Updates to Cholecystectomy Medical Review Criteria


Harvard Pilgrim is updating our commercial and StrideSM (HMO) Medicare Advantage medical review criteria for cholecystectomy surgery. Harvard Pilgrim covers medically necessary laparoscopic or open cholecystectomy procedures, with prior authorization, when all criteria indicated in these policies are met.

Effective for dates of service beginning Jan. 1, 2018, we are updating the commercial and Stride medical review criteria policies to require prior authorization for the following CPT codes:  

  • 47564 – Laparoscopy, surgical; cholecystectomy with exploration of common duct
  • 47579 – Unlisted laparoscopy procedure, biliary tract 
  • 47610 – Cholecystectomy with exploration of common duct

CPT codes 47562, 47563, 47600, and 47605 will remain covered and will continue to require prior authorization.

For more information, and for complete coverage criteria and exclusions, please refer to Harvard Pilgrim’s updated Cholecystectomy Medical Review Criteria and StrideSM (HMO) Medicare Advantage Cholecystectomy Medical Review Criteria.

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