00104 CPT® code: payer coverage and prior authorization3 of 3 payer prior-auth lists that name 00104 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Blue Shield of California.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Shield of California | Blue Shield Medicare | CA | prior auth required | Sep 1, 2026 | Prior Authorization List for Blue Shield Medicare | |
| Blue Shield of California | Blue Shield commercial | CA | prior auth required | Sep 1, 2026 | Prior Authorization List for Blue Shield | |
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jul 1, 2026 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
00104 appears in 4 coverage policies from Aetna, Anthem, Blue Shield of California.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Eating Disorders (0511) | listed, no stance | Aug 4, 2026 | payer document |
| Aetna | Electroconvulsive Therapy (0445) | covered if criteria are met | Jul 29, 2026 | payer document |
| Anthem | Anesthesia Services and Moderate (“Conscious”) Sedation (CG-MED-21) | covered if criteria are met (range 00100-00222) | Nov 6, 2025 | payer document |
| Blue Shield of California | BSC8.09 | Electroconvulsive Therapy | listed, no stance | payer document |
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.