Payer policies › CPT 0362T0362T CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 0362T 24 of 24 payer prior-auth lists that name 0362T require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Shield of California, HealthSpring, Humana, Molina Healthcare of Michigan, Molina Healthcare of Texas.
Payer Plan State Prior auth Conditions Since Source Blue Cross Blue Shield of Arizona (AZ Blue) Federal Employee Program (FEP) AZ prior auth required Sep 1, 2026 Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) Blue Cross Blue Shield of Arizona (AZ Blue) Standard PA code list (most commercial plans) AZ prior auth required Sep 1, 2026 AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026) Blue Cross Blue Shield of Arizona (AZ Blue) State of Arizona employee group (SYD, S3Z) AZ prior auth required Sep 1, 2026 State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) Blue Cross Blue Shield of Arizona (AZ Blue) Teamsters group (TYW) AZ prior auth required Sep 1, 2026 Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026) Blue Shield of California Blue Shield commercial CA prior auth required Sep 1, 2026 Prior Authorization List for Blue Shield Aetna Commercial All prior auth required Aug 1, 2024 Participating provider behavioral health precertification list for Aetna Aetna Medicare Advantage All prior auth required Aug 1, 2024 Participating provider behavioral health precertification list for Aetna Blue Cross and Blue Shield of Illinois Blue Cross Community Health Plans (BCCHP), Illinois Medicaid IL prior auth required Jan 1, 2026 Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026 Blue Cross and Blue Shield of Illinois Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative) IL prior auth required Jan 1, 2025 Procedure Code List, Effective 1/1/2025 HealthSpring Medicare Advantage All prior auth required Aug 1, 2026 2026 Q4 Prior Authorization List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida 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 Healthy Horizons FL prior auth required Jan 1, 2027 1102002FL1026 FLHN8CBEN Humana Healthy Horizons in Florida Preauthorization and Notification List Humana Humana Healthy Horizons IL prior auth required Jan 1, 2027 Humana Healthy Horizons in Illinois Prior Authorization and Notification List To view -specific medical coverage policies, please visit Humana Healthy Horizons in Illinois Clinical coverage policies . Humana Humana Healthy Horizons LA prior auth required Jan 1, 2027 Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate Humana Humana Healthy Horizons OH prior auth required Jan 1, 2027 555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list Humana Humana Healthy Horizons SC prior auth required Jan 1, 2027 Humana Healthy Horizons in South Carolina Prior authorization and Notification List The following list describes services and medications that are commonly reviewed and may require additional clinical Humana Humana Healthy Horizons VA prior auth required Jan 1, 2027 Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) 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 Texas STAR TX prior auth required Feb 19, 2025 Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19 Molina Healthcare of Texas STAR+PLUS TX prior auth required Feb 19, 2025 Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19 Molina Healthcare of Texas STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix) TX prior auth required Jul 1, 2026 Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 Molina Healthcare of Texas Exchange TX prior auth required Sep 1, 2019 Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026
Payer coverage policies that name 0362T 0362T appears in 9 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Blue Shield of California, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Aetna Applied Behavior Analysis (0554) listed, no stance Nov 26, 2025 payer document Aetna Autism Spectrum Disorders (0648) listed, no stance Oct 2, 2025 payer document Blue Cross & Blue Shield of Mississippi Treatment Of Autism Spectrum Disorder Asd (L.8.01.403) listed, no stance payer document Blue Cross & Blue Shield of Rhode Island Autism Spectrum Disorders Mandate covered if criteria are met Apr 15, 2026 payer document Blue Cross NC Adaptive Behavioral Treatment for Autism Spectrum Disorders listed, no stance Jun 1, 2026 payer document Blue Shield of California Applied Behavior Analysis for Autism Spectrum Disorder or BSC3.01 Pervasive Developmental Disorder listed, no stance payer document Centene Applied Behavior Analysis (CP.BH.104) covered if criteria are met Jun 1, 2020 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 Premera Blue Cross Applied Behavior Analysis (ABA) (3.01.510) listed, no stance Apr 27, 2026 payer document
Recent prior-auth changes Jan 1, 2027: PA added, Humana Aug 1, 2026: PA added, HealthSpring Jul 1, 2026: PA removed, Humana Jan 1, 2026: PA removed, Molina Healthcare of Michigan Jan 1, 2026: conditions changed, Blue Cross and Blue Shield of Illinois Aug 9, 2024: PA removed, humana:pa:commercial Medicaid fee-for-service Prior authorization required or conditional in IN, MD, MS.
IN: $22.81 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2026 LA: $10.00 (epsdt), effective Mar 20, 2019 MS: $56.64 (comprehensive), effective Dec 1, 2025 ND: $0.00 (physician), effective Aug 1, 2026 VA: $76.62 (medical), effective Dec 1, 2021 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $58.80 (aba), 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.