0544T CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 0544T require prior authorization or set conditions: HealthSpring.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| HealthSpring | Medicare Advantage | All | prior auth required | Aug 1, 2026 | 2026 Q4 Prior Authorization List |
0544T appears in 19 coverage policies from Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Shield of California, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Anthem | Transcatheter Mitral, Pulmonary, and Tricuspid Heart Valve Procedures (SURG.00121) | unproven / investigational | Feb 19, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Transcatheter Mitral Valve Repair Or Replacement | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Transcatheter Mitral Valve Repair or Replacement | listed, no stance | Sep 17, 2025 | payer document |
| Blue Shield of California | Transcatheter Mitral Valve Repair or Replacement (2.02.30) | listed, no stance | payer document | |
| Capital Blue Cross | Experimental and Investigational Procedures (MP 4.002) Procedure codes: Cardiac | listed, no stance | Sep 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 |
| Premera Blue Cross | Transcatheter Mitral Valve Repair or Replacement (2.02.30) Page | 4 of 30 | ∞ | listed, no stance | Jul 8, 2025 | payer document |
| Regence | Transcatheter Heart Valve Procedures for Mitral or Tricuspid Valve Disorders (Surgery 221) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Category III CPT Codes (MMP043.49) tendineae | Policy titled | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Transcatheter Procedures for Heart Valve Conditions (2026T0557FF) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Transcatheter Procedures for Heart Valve Conditions (CS123.X) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Transcatheter Procedures for Heart Valve Conditions (for Indiana Only) (CS123IN.12) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Transcatheter Procedures for Heart Valve Conditions (for Kansas Only) (CS123KS.03) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Transcatheter Procedures for Heart Valve Conditions (for Kentucky Only) (CS123KY.14) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Transcatheter Procedures for Heart Valve Conditions (for Nebraska Only) (CS123NE.V) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Transcatheter Procedures for Heart Valve Conditions (for New Mexico Only) (CS123NM.D) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Transcatheter Procedures for Heart Valve Conditions (for Ohio Only) (CS123OH.F) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Transcatheter Procedures for Heart Valve Conditions (for Pennsylvania Only) (CS123PA.X) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Transcatheter Procedures for Heart Valve Conditions (for Tennessee Only) (CS123TN.W) | 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.