0789T CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 0789T 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 |
0789T appears in 7 coverage policies from Aetna, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | not covered (range 0784T-0789T) | Jun 19, 2026 | payer document |
| Capital Blue Cross | Sacral Nerve Neuromodulation-Stimulation (MP 1.033) Procedure codes | covered if criteria are met | May 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) | Sacral Nerve Neuromodulation/Stimulation (SUR710.018) CPT Codes 64561, 64581, 64585, 64590, 64595, 95970, 95971, 0786T, 0787T, 0788T, | listed, no stance | Oct 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) Stimulation (SUR712.009) CPT Codes 63650, 63655, 63661, 63662, 63663, 63664, 63685, 63688, 95970, | listed, no stance | Aug 1, 2026 | payer document |
| Regence | Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction (Surgery 134) | listed, no stance | Oct 1, 2025 | payer document |
| Regence | Spinal Cord and Dorsal Root Ganglion Stimulation (Surgery 45) | listed, no stance | Mar 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.