0717T CPT® code: payer coverage and prior authorization10 of 12 payer prior-auth lists that name 0717T require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Texas, Cigna, HealthSpring, Molina Healthcare of Iowa, Molina Healthcare of Ohio.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | Federal Employee Program (FEP) | AZ | prior auth under conditions | FEP Blue Focus only | Sep 1, 2026 | Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Jul 1, 2022 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Jul 1, 2022 | Master Precertification List (For Health Care Providers) |
| Cigna | Musculoskeletal | All | prior auth required | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs | |
| Cigna | Musculoskeletal | All | prior auth required | Mar 7, 2026 | Cigna Commercial Prior Authorization Procedure Code List: Musculoskeletal - Joint Surgery | |
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jul 1, 2026 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
| HealthSpring | Medicare Advantage | All | prior auth required | Aug 1, 2026 | 2026 Q4 Prior Authorization List | |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| 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 |
0717T appears in 17 coverage policies from Aetna, Anthem, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Molina Healthcare, Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Blood and Adipose Tissue Derived Products for Selected Indications (0784) | not covered | Nov 19, 2025 | payer document |
| Anthem | Autologous Adipose-derived Regenerative Cell Therapy (MED.00132) | unproven / investigational | Nov 6, 2025 | payer document |
| Capital Blue Cross | Experimental and Investigational Procedures (MP 4.002) Procedure codes: Musculoskeletal | 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 |
| Molina Healthcare | Stem Cell Therapy for Orthopedic Applications Policy No. 426 (426) N | e | x | t | R | e | v | i | e | w | D | u | e | B | y | : | O | c | t | o | b | e | r | listed, no stance | Oct 8, 2025 | payer document |
| Premera Blue Cross | Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used with Autologous Bone Marrow) (8.01.52) Page | 2 of 17 | ∞ | listed, no stance | Oct 1, 2026 | payer document |
| Regence | Orthopedic Applications of Stem Cell Therapy, Including Bone Substitutes Used with Autologous Bone Marrow (Medicine 142) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Autologous Cellular Therapy (CS176.I) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Autologous Cellular Therapy (2026T0612M) | 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) volume less than 50 mL | Commercial Medical | 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.