0263T CPT® code: payer coverage and prior authorization21 of 22 payer prior-auth lists that name 0263T require prior authorization or set conditions: 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), Rocky Mountain Health Plans, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| 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 | |
| Rocky Mountain Health Plans | Rocky Mountain Health Plans CHP+ | CO | prior auth required | Oct 1, 2026 | Rocky Mountain Children’s Health Plan - prior authorization 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 |
0263T appears in 24 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell Transplantation (0599) | not covered | Sep 18, 2026 | payer document |
| Anthem | Therapeutic use of Stem Cells, Blood and Bone Marrow Products (TRANS.00035) | unproven / investigational | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Stem Cell Therapy For Peripheral Arterial Disease | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Orthopedic Applications of Stem Cell Therapy | not covered | Sep 16, 2026 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Stem Cell Therapy for Peripheral Arterial Disease | not covered | Mar 18, 2026 | payer document |
| Blue Cross Blue Shield of Massachusetts | Orthopedic Applications of Stem Cell Therapy (254) | unproven / investigational | payer document | |
| Blue Cross Blue Shield of Massachusetts | Stem-Cell Therapy for Peripheral Arterial Disease (348) | unproven / investigational | payer document | |
| Blue Cross NC | Stem-cell Therapy for Peripheral Arterial Disease | listed, no stance | Oct 1, 2025 | payer document |
| Blue Shield of California | Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used with Autologous Bone Marrow) (8.01.52) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Stem-Cell Therapy for Peripheral Arterial Disease (CAM 80155) | listed, no stance | May 1, 2026 | payer document |
| Capital Blue Cross | Stem Cell Therapy for Peripheral Arterial Disease (MP 2.089) Procedure codes | unproven / investigational | Jun 1, 2026 | 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 |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Stem Cell Therapy for Peripheral Arterial Disease (SUR703.048) | listed, no stance | Apr 15, 2026 | payer document |
| Premera Blue Cross | Stem Cell Therapy for Peripheral Arterial Disease (8.01.55) | listed, no stance | Mar 9, 2026 | payer document |
| UnitedHealthcare | Autologous Cellular Therapy (2026T0612M) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Autologous Cellular Therapy (CS176.I) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Autologous Cellular Therapy (for Kansas Only) (CS176KS.04) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Autologous Cellular Therapy (for Kentucky Only) (CS301KY.09) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Autologous Cellular Therapy (for Nebraska Only) (CS176NE.H) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Autologous Cellular Therapy (for New Mexico Only) (CS176NM.E) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Autologous Cellular Therapy (for Ohio Only) (CS176OH.D) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Autologous Cellular Therapy (for Pennsylvania Only) (CS176PA.H) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Autologous Cellular Therapy (for Tennessee Only) (CS176TN.H) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Category III CPT Codes (MMP043.49) including fluoroscopy, single level, | Decompression. | listed, no stance | Sep 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.