01960 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 01960

Payer coverage policies that name 01960

01960 appears in 4 coverage policies from Anthem, Blue Cross & Blue Shield of Mississippi, BlueCross BlueShield of South Carolina, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AnthemAnesthesia Services and Moderate (“Conscious”) Sedation (CG-MED-21)covered if criteria are met (range 01958-01969)Nov 6, 2025payer document
Blue Cross & Blue Shield of MississippiMedically Indicated Earlyterm Deliveries Prior To 39 Weeks (L.4.01.400)listed, no stancepayer document
BlueCross BlueShield of South CarolinaMaternity/Obstetrical Care Benefits (CAM 366)listed, no stanceFeb 1, 2026payer document
UnitedHealthcarePreventive Care Services (MP.016.59)
approved, granted, or cleared by | diagnosis code listed in this row.
listed, no stanceJul 1, 2026payer document

Medicaid fee-for-service

  • AZ: $32.12 (anesthesia), effective Oct 1, 2026
  • CO: $16.98 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $82.33 (physician, non-facility), effective Jan 1, 2026
  • IN: $0.00 (professional, facility), effective Oct 16, 2003
  • KY: $215.00 (physician, facility), effective Jan 1, 2026
  • MA: $5.00 (anesthesia), effective Aug 1, 2021
  • MS: $5.00 (anesthesia), effective Oct 1, 2003
  • NY: $5.00 (physician_anesthesia), effective Apr 1, 2026
  • OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
  • TX: $271.97 (certified_registered_nurse_anesthetist_crna_anesthesiologist, Certified Registered Nurse Anesthetist (Crna) / Anesthesiologist Assistant (Aa), facility), effective Nov 1, 2017
  • VA: $4.00 (medical), effective Jan 1, 2002
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $5.00 (physician, facility), effective Jul 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

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.