0200T CPT® code: payer coverage and prior authorization29 of 30 payer prior-auth lists that name 0200T require prior authorization or set conditions: Cigna, HealthSpring, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of South Carolina, Molina Healthcare of Texas, Molina Healthcare of Utah, Molina Healthcare of Washington, Molina Healthcare of Wisconsin, Molina Healthcare, Inc. (national grid), UnitedHealthcare, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Jul 1, 2009 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Jul 1, 2009 | Master Precertification List (For Health Care Providers) |
| Cigna | Musculoskeletal | All | prior auth required | Mar 7, 2026 | Cigna Commercial Prior Authorization Procedure Code List: Musculoskeletal - Spine Surgery | |
| Cigna | Musculoskeletal | All | prior auth required | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs | |
| HealthSpring | Medicare Advantage | All | prior auth required | Aug 1, 2026 | 2026 Q4 Prior Authorization List | |
| 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 | |
| Molina Healthcare of California | Medicare Advantage | CA | prior auth required | Jul 1, 2021 | Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021 | |
| Molina Healthcare of Florida | Medicare Advantage | FL | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021 | |
| Molina Healthcare of Idaho | Medicare Advantage | ID | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021 | |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Molina Healthcare of Michigan | Exchange | MI | prior auth required | Jul 1, 2021 | Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 | |
| Molina Healthcare of Nevada | Medicaid | NV | prior auth required | Oct 1, 2022 | Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 | |
| Molina Healthcare of New Mexico | Medicare Advantage | NM | prior auth required | Jan 1, 2021 | Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021 | |
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Medicare and MyCare Ohio (MMP) Medicare | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Exchange | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of South Carolina | Medicare Advantage | SC | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021 | |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Sep 1, 2019 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 | |
| Molina Healthcare of Utah | Medicare Advantage | UT | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021 | |
| Molina Healthcare of Washington | Medicare Advantage | WA | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021 | |
| Molina Healthcare of Wisconsin | Medicare Advantage | WI | prior auth required | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021 | |
| Molina Healthcare, Inc. (national grid) | Molina national (MHI) Medicare grid | All | prior auth required | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021 | |
| UnitedHealthcare | Preferred Care Network and Preferred Care Partners of Florida | FL | prior auth required | Oct 1, 2026 | Prior authorization requirements for Preferred Care Network and Preferred Care Partners of Florida Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Medicare Advantage, Peoples Health and Dual Complete (D-SNP) | All | prior auth required | Excluded plans: Erickson Advantage | Oct 1, 2026 | UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Massachusetts OneCare | MA | prior auth required | Nov 1, 2025 | Prior authorization requirements for Massachusetts OneCare Effective November 1, 2025 | |
| UnitedHealthcare Community Plan | Massachusetts Senior Care Options (SCO) | MA | prior auth required | Nov 1, 2025 | CPT® is a registered trademark of the American Medical Association. Prior authorization requirements for Massachusetts Senior Care Options Effective November 1, 2025 | |
| UnitedHealthcare Community Plan | Massachusetts Senior Care Options (SCO) and OneCare | MA | prior auth required | Oct 1, 2026 | Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | UnitedHealthcare Connected (Texas MMP) | TX | prior auth required | Jan 1, 2015 | Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U |
0200T appears in 16 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Back Pain - Invasive Procedures (0016) | not covered | Oct 6, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Minimally Invasive Approaches To Vertebral Fractures And Osteolytic Lesions Of The Spine | unproven / investigational | payer document | |
| Blue Shield of California | Minimally Invasive Approaches to Vertebral Fractures and Osteolytic Lesions of the Spine (6.01.25) | listed, no stance | payer document | |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Category III Current Procedural Terminology (CPT®) Codes CPT Codes 0054T, 0055T, 0071T, 0072T, 0075T, 0076T, 0095T, 0098T, 0100T, 0101T, | listed, no stance | Jan 1, 2027 | payer document |
| Premera Blue Cross | Minimally Invasive Approaches to Vertebral Fractures and Osteolytic Lesions of the Spine (6.01.25) | listed, no stance | Jun 8, 2026 | payer document |
| Regence | Percutaneous Vertebroplasty, Kyphoplasty, Sacroplasty, and Coccygeoplasty (Surgery 107) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Spine Surgery Procedures (2026T0640H) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Spine Surgery Procedures (CS364.D) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Spine Surgery Procedures (for Kansas Only) (CS364KS.02) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Spine Surgery Procedures (for Kentucky Only) (CS364KY.04) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Spine Surgery Procedures (for Nebraska Only) (CS364NE.D) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Spine Surgery Procedures (for New Mexico Only) (CS364NM.C) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Spine Surgery Procedures (for Ohio Only) (CS364OH.D) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Spine Surgery Procedures (for Pennsylvania Only) (CS364PA.D) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Spine Surgery Procedures (for Tennessee Only) (CS364TN.D) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Spine Procedures (MMP089.18) Percutaneous Sacral Augmentation (Sacroplasty) | listed, no stance | Aug 1, 2026 | payer document |
Prior authorization required or conditional in IN.
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.