Payer policies › CPT 0746T0746T CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 0746T 21 of 24 payer prior-auth lists that name 0746T require prior authorization or set conditions: CarePlus Health Plans, Cigna, HealthSpring, Humana, Molina Healthcare of Iowa, Molina Healthcare of Ohio, Molina Healthcare of Texas, Oxford Health Plans, UnitedHealthcare.
Payer Plan State Prior auth Conditions Since Source Cigna ACA/IFP All prior auth required May be delegated to eviCore for some clients Jan 1, 2023 Master Precertification List (For Health Care Providers) Cigna Basic Standard All prior auth required May be delegated to eviCore for some clients Jan 1, 2023 Master Precertification List (For Health Care Providers) Cigna Complete/PHS+/Preferred All prior auth required May be delegated to eviCore for some clients Jan 1, 2023 Master Precertification List (For Health Care Providers) HealthSpring Medicare Advantage All prior auth required Jan 1, 2025 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 (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 (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 Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management 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 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 Oxford Health Plans Oxford Health Plans All prior auth required Oct 1, 2026 Prior Authorization Requirements for Oxford Effective October 1, 2026 UnitedHealthcare UnitedHealthcare West commercial plans All prior auth required Oct 1, 2026 Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026
Payer coverage policies that name 0746T 0746T appears in 6 coverage policies from Aetna, Anthem, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence.
Payer Policy Role in policy Reviewed Document Aetna Cardiac Catheter Ablation (0165) not covered Aug 25, 2026 payer document Anthem Electrophysiology-Guided Noninvasive Stereotactic Cardiac Radioablation (THER-RAD.00012) unproven / investigational May 14, 2026 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®) CodesCPT Codes 0054T, 0055T, 0071T, 0072T, 0075T, 0076T, 0095T, 0098T, 0100T, 0101T, listed, no stance Jan 1, 2027 payer document Premera Blue Cross Non-covered Experimental/Investigational ServicesPage | 9 of 38 | ∞ listed, no stance Oct 1, 2026 payer document Regence New and Emerging Medical Technologies and Procedures (Medicine 149) listed, no stance Jun 1, 2026 payer document
Recent prior-auth changes Jul 1, 2026: PA added, HealthSpring Nov 1, 2025: PA removed, Blue Cross and Blue Shield of Illinois Jul 1, 2025: PA removed, Humana Jan 1, 2025: PA removed, Molina Healthcare of Texas Jan 1, 2023: PA added, Molina Healthcare of Ohio Jan 1, 2023: PA added, Molina Healthcare of Texas Jan 1, 2023: PA added, humana:pa:commercial Medicaid fee-for-service IN: $0.00 (professional, facility), effective Jan 1, 2023 ND: $0.00 (physician), 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.