0786T CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0786T

12 of 12 payer prior-auth lists that name 0786T require prior authorization or set conditions: CarePlus Health Plans, HealthSpring, Humana.

PayerPlanStatePrior authConditionsSinceSource
HealthSpringMedicare AdvantageAllprior auth requiredAug 1, 20262026 Q4 Prior Authorization List
CarePlus Health PlansCarePlus Health PlansFLprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaHumana D-SNP (FL)FLprior auth requiredJan 1, 20271 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
HumanaHumana D-SNP (IL)ILprior auth requiredJan 1, 2027Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
HumanaHumana D-SNP (IN)INprior auth requiredJan 1, 2027*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
HumanaHumana D-SNP (MI)MIprior auth requiredJan 1, 20271 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
HumanaHumana D-SNP (SC)SCprior auth requiredJan 1, 2027Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
HumanaHumana D-SNP (VA)VAprior auth requiredJan 1, 2027Virginia Prior Authorization and Notification List
HumanaHumana Healthy HorizonsVAprior auth requiredJan 1, 2027Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
HumanaHumana MA and D-SNPAllprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaHumana Puerto Rico MA and Dual Medicare-MedicaidPRprior auth requiredNov 3, 2025Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management

Payer coverage policies that name 0786T

0786T appears in 15 coverage policies from Aetna, Anthem, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaIntraoperative Neurophysiological Monitoring (0697)not covered (range 0784T-0789T)Jun 19, 2026payer document
AnthemSacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence (CG-SURG-95)covered if criteria are metAug 13, 2026payer document
Capital Blue CrossSacral Nerve Neuromodulation-Stimulation (MP 1.033)
Procedure codes		covered if criteria are metMay 1, 2026payer 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 stanceJan 1, 2027payer document
Premera Blue CrossSacral Nerve Neuromodulation/Stimulation (7.01.69)listed, no stanceJun 8, 2026payer document
UnitedHealthcareSacral Nerve Stimulation for Urinary and Fecal Indications (2026T0630J)listed, no stanceJan 1, 2026payer document
UnitedHealthcareSacral Nerve Stimulation for Urinary and Fecal Indications (CS358.E)listed, no stanceDec 1, 2025payer document
UnitedHealthcareSacral Nerve Stimulation for Urinary and Fecal Indications (for Idaho Only) (CS358ID.B)listed, no stanceMay 1, 2026payer document
UnitedHealthcareSacral Nerve Stimulation for Urinary and Fecal Indications (for Kansas Only) (CS358KS.02)listed, no stanceJan 1, 2026payer document
UnitedHealthcareSacral Nerve Stimulation for Urinary and Fecal Indications (for Kentucky Only) (CS358KY.05)listed, no stanceApr 1, 2026payer document
UnitedHealthcareSacral Nerve Stimulation for Urinary and Fecal Indications (for Nebraska Only) (CS358NE.E)listed, no stanceDec 1, 2025payer document
UnitedHealthcareSacral Nerve Stimulation for Urinary and Fecal Indications (for New Mexico Only) (CS358NM.D)listed, no stanceDec 1, 2025payer document
UnitedHealthcareSacral Nerve Stimulation for Urinary and Fecal Indications (for Ohio Only) (CS358OH.E)listed, no stanceJan 1, 2026payer document
UnitedHealthcareSacral Nerve Stimulation for Urinary and Fecal Indications (for Pennsylvania Only) (CS258PA.E)listed, no stanceDec 1, 2025payer document
UnitedHealthcareSacral Nerve Stimulation for Urinary and Fecal Indications (for Tennessee Only) (CS358TN.E)listed, no stanceDec 1, 2025payer document

Recent prior-auth changes

  • Aug 1, 2026: PA added, HealthSpring
  • Jan 1, 2024: PA added, humana:pa:commercial

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • KY: $9089.60 (asc), effective Jan 1, 2026
  • 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.