0806T CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0806T

33 of 33 payer prior-auth lists that name 0806T require prior authorization or set conditions: CarePlus Health Plans, Cigna, HealthSpring, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Passport by Molina Healthcare (Kentucky).

PayerPlanStatePrior authConditionsSinceSource
CignaACA/IFPAllprior auth requiredMay be delegated to eviCore for some clientsJul 1, 2023Master Precertification List (For Health Care Providers)
CignaBasic StandardAllprior auth requiredMay be delegated to eviCore for some clientsJul 1, 2023Master Precertification List (For Health Care Providers)
CignaCardiologyAllprior auth requiredMar 7, 2026Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
CignaCardiologyAllprior auth requiredMar 7, 2026Cigna Commercial Prior Authorization Procedure Code List: Cardiology
CignaComplete/PHS+/PreferredAllprior auth requiredMay be delegated to eviCore for some clientsJul 1, 2023Master Precertification List (For Health Care Providers)
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 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
Molina Complete Care (Virginia)MedicaidVAprior auth requiredApr 1, 2025Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
Molina Healthcare of CaliforniaMedicaidCAprior auth requiredApr 1, 2026Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of IdahoMedicaidIDprior auth requiredJan 1, 2025Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
Molina Healthcare of IllinoisMedicaidILprior auth requiredOct 1, 2023Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of MichiganMedicare AdvantageMIprior auth requiredJul 1, 2026Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of MichiganMedicaidMIprior auth requiredJul 1, 2026Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of MississippiMedicaidMSprior auth requiredJan 1, 2025Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
Molina Healthcare of New MexicoMedicaidNMprior auth requiredJul 1, 2026New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026
Molina Healthcare of OhioMedicaid and MyCare Ohio (MMP) MedicaidOHprior auth requiredOct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of OhioMedicare and MyCare Ohio (MMP) MedicareOHprior auth requiredOct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of OhioExchangeOHprior auth requiredOct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of TexasSTARTXprior auth requiredFeb 19, 2025Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19
Molina Healthcare of TexasSTAR+PLUSTXprior auth requiredFeb 19, 2025Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19
Molina Healthcare of TexasSTAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix)TXprior auth requiredOct 1, 2023Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3
Molina Healthcare of TexasExchangeTXprior auth requiredOct 1, 2023Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026
Molina Healthcare of UtahMedicaidUTprior auth requiredJan 1, 2025Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
Passport by Molina Healthcare (Kentucky)MedicaidKYprior auth requiredJul 1, 2026Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026

Payer coverage policies that name 0806T

0806T appears in 16 coverage policies from Aetna, Blue Cross NC, Capital Blue Cross, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaPercutaneous Mitral Valve and Tricuspid Valve Repair (0880)not coveredAug 25, 2026payer document
Blue Cross NCTranscatheter Heart Valve Procedureslisted, no stanceJun 1, 2026payer document
Capital Blue CrossExperimental and Investigational Procedures (MP 4.002)
Procedure codes: Cardiac		listed, no stanceSep 1, 2026payer document
CignaCategory III Current Procedural Terminology (CPT®) codes (0558)unproven / investigationalSep 15, 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
RegenceTranscatheter Heart Valve Procedures for Mitral or Tricuspid Valve Disorders (Surgery 221)listed, no stanceJun 1, 2026payer document
UnitedHealthcareCategory III CPT Codes (MMP043.49)
femoral vein approach | Policy titled		listed, no stanceSep 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (2026T0557FF)listed, no stanceJul 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (CS123.X)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Kansas Only) (CS123KS.03)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Kentucky Only) (CS123KY.14)listed, no stanceSep 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Nebraska Only) (CS123NE.V)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for New Mexico Only) (CS123NM.D)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Ohio Only) (CS123OH.F)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Pennsylvania Only) (CS123PA.X)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Tennessee Only) (CS123TN.W)listed, no stanceAug 1, 2026payer document

Recent prior-auth changes

  • Aug 1, 2026: PA added, HealthSpring
  • Jan 1, 2026: PA added, Molina Healthcare of Michigan
  • Jan 1, 2026: PA added, Molina Healthcare of Michigan
  • Feb 19, 2025: PA added, Molina Healthcare of Texas
  • Feb 19, 2025: PA added, Molina Healthcare of Texas
  • Jan 1, 2025: PA added, Molina Healthcare of Texas
  • Oct 1, 2023: PA added, Molina Healthcare of Ohio
  • Oct 1, 2023: PA added, Molina Healthcare of Ohio
  • Oct 1, 2023: PA added, Molina Healthcare of Ohio
  • Jul 1, 2023: PA added, humana:pa:commercial

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • KS: $0.00 (default, Exempt Physician), effective Jul 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.