0672T CPT® code: payer coverage and prior authorization9 of 9 payer prior-auth lists that name 0672T require prior authorization or set conditions: HealthSpring, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of Iowa, Molina Healthcare of Nevada, Molina Healthcare of Ohio, Molina Healthcare of Texas.
| 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 Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Molina Healthcare of Nevada | Medicaid | NV | prior auth required | Oct 1, 2022 | Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 | |
| 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 Texas | Exchange | TX | prior auth required | PA Modernization - PA requirements will be removed where covered | Jan 1, 2024 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 |
0672T appears in 10 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, 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 |
|---|---|---|---|---|
| Aetna | Female Sexual Dysfunction (FSD) (0574) | not covered | Sep 10, 2026 | payer document |
| Anthem | Treatments for Urinary Incontinence (CG-SURG-134) | not covered | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Transvaginal And Transurethral Radiofrequency Tissue Remodeling For Urinary Stress Incontinence (L.2.01.426) | unproven / investigational | payer document | |
| Capital Blue Cross | Experimental and Investigational Procedures (MP 4.002) Procedure codes: Genitourinary | 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 |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Radiofrequency Energy Therapy for Stress Urinary Incontinence (SUR710.021) | listed, no stance | Jan 1, 2026 | payer document |
| Premera Blue Cross | Non-covered Experimental/Investigational Services Page | 5 of 38 | ∞ | listed, no stance | Oct 1, 2026 | payer document |
| Regence | New and Emerging Medical Technologies and Procedures (Medicine 149) percutaneous, with magnetic | (CoapTech) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Omnibus Codes (for Ohio Only) (CS087OH.G) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Urinary and Fecal Incontinence: Diagnosis and Treatment (MMP049.14) Radiofrequency (RF) Therapy for Treatment of Stress Urinary Incontinence (e.g., Viveve System) | 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.