01939 CPT® code: payer coverage and prior authorization2 of 3 payer prior-auth lists that name 01939 require prior authorization or set conditions: Molina Complete Care (Virginia), Molina Healthcare of Arizona.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Complete Care (Virginia) | Medicare-only PA matrix for D-SNP | VA | prior auth required | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022 | |
| Molina Healthcare of Arizona | Medicare-only PA matrix for D-SNP | AZ | prior auth required | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022 |
01939 appears in 3 coverage policies from Anthem, Blue Shield of California, Cigna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Anthem | Anesthesia Services for Interventional Pain Management Procedures (CG-MED-78) | covered if criteria are met | Aug 13, 2026 | payer document |
| Blue Shield of California | | Monitored Anesthesia Care (7.02.01) | listed, no stance | payer document | |
| Cigna | Anesthesia Services for Interventional Pain Management Procedures in an Adult (0551) | covered if criteria are met | Sep 15, 2026 | 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.