0804T CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 0804T 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 |
0804T appears in 10 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Blue Shield of California, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Leadless Cardiac Pacemaker (0893) | covered if criteria are met | Dec 22, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | Leadless Cardiac Pacemakers | listed, no stance | payer document | |
| Blue Cross NC | Leadless Cardiac Pacemakers | listed, no stance | Jun 1, 2026 | payer document |
| Blue Shield of California | Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure (2.02.10) | listed, no stance | payer document | |
| Blue Shield of California | | Leadless Cardiac Pacemakers (2.02.32) | listed, no stance | payer document | |
| Capital Blue Cross | Experimental and Investigational Procedures (MP 4.002) Procedure codes: Miscellaneous | 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) | Leadless Cardiac Pacemakers (SUR707.030) CPT Codes 33274, 33275, 0795T, 0796T, 0797T, 0798T, 0799T, 0800T, 0801T, 0802T, | listed, no stance | Nov 1, 2025 | payer document |
| Regence | Dual Chamber Leadless Cardiac Pacemakers (Surgery 217) | listed, no stance | Oct 1, 2025 | payer document |
| UnitedHealthcare | Category III CPT Codes (MMP043.49) including imaging guidance (e.g., | (20.8.4) | 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.