Payer policies › CPT 0339T0339T CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 0339T 27 of 28 payer prior-auth lists that name 0339T require prior authorization or set conditions: CarePlus Health Plans, HealthSpring, Humana, 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).
Payer Plan State Prior auth Conditions Since Source HealthSpring Medicare Advantage All prior auth required Aug 1, 2026 2026 Q4 Prior Authorization List CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification 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
Payer coverage policies that name 0339T 0339T appears in 14 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Capital Blue Cross, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Renal Sympathetic Nerve Ablation (0847) not covered (range 0338T-0339T) Dec 18, 2025 payer document Anthem Renal Denervation for Hypertension (SURG.00135) unproven / investigational Feb 19, 2026 payer document Blue Cross & Blue Shield of Mississippi Renal Denervation For Uncontrolled Hypertension (A.7.01.136) listed, no stance payer document Blue Cross & Blue Shield of Rhode Island Radiofrequency Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled Hypertension not covered Apr 2, 2025 payer document Blue Cross & Blue Shield of Rhode Island Renal Denervation for Uncontrolled Hypertension covered if criteria are met Jun 3, 2026 payer document Blue Cross NC Renal Denervation as a Treatment of Hypertension listed, no stance Feb 1, 2026 payer document Blue Shield of California Renal Denervation for Uncontrolled Hypertension (7.01.136) listed, no stance payer document BlueCross BlueShield of South Carolina Renal Denervation for Uncontrolled Hypertension (CAM 701136) listed, no stance Aug 1, 2026 payer document Capital Blue Cross Renal Denervation for Uncontrolled Hypertension (MP 1.166)Procedure codes covered if criteria are met Apr 1, 2026 payer document Cigna Category III Current Procedural Terminology (CPT®) codes (0558) unproven / investigational Sep 15, 2026 payer document Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) Category III Current Procedural Terminology (CPT®) CodesCPT 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) Renal Denervation for Uncontrolled Hypertension (SUR701.030) listed, no stance Oct 15, 2025 payer document Regence Radiofrequency and Ultrasound Ablation of the Renal Sympathetic Nerves as a Treatment for Uncontrolled Hypertension (Surgery 235) listed, no stance Aug 1, 2025 payer document UnitedHealthcare Omnibus Codes (MMP107.09)(A57060) | states/territories with listed, no stance Jun 1, 2026 payer document
Recent prior-auth changes Aug 1, 2026: PA added, HealthSpring Jan 1, 2026: PA removed, Molina Healthcare of Michigan Mar 1, 2025: PA removed, Rocky Mountain Health Plans Mar 1, 2025: PA removed, Rocky Mountain Health Plans Feb 19, 2025: PA removed, Molina Healthcare of Texas Feb 19, 2025: PA removed, Molina Healthcare of Texas Jan 1, 2025: PA removed, Molina Healthcare of Texas Medicaid fee-for-service Prior authorization required or conditional in IN.
KY: $4075.48 (asc), effective Jan 1, 2026 ND: $2402.49 (physician, facility), effective Aug 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 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.