`0807T` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0807T

6 of 6 payer prior-auth lists that name 0807T require prior authorization or set conditions: Cigna, HealthSpring.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Cigna	ACA/IFP	All	prior auth required	May be delegated to eviCore for some clients	Jul 1, 2023	Master Precertification List (For Health Care Providers)
Cigna	Basic Standard	All	prior auth required	May be delegated to eviCore for some clients	Jul 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	Jul 1, 2023	Master Precertification List (For Health Care Providers)
Cigna	Other Services	All	prior auth required	Experimental/investigational	Mar 7, 2026	Cigna Commercial Prior Authorization Procedure Code List: Other Services
Cigna	Other Services	All	prior auth required	Experimental/investigational	Mar 7, 2026	Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
HealthSpring	Medicare Advantage	All	prior auth required		Aug 1, 2026	2026 Q4 Prior Authorization List

Payer coverage policies that name 0807T

0807T appears in 7 coverage policies from Aetna, Capital Blue Cross, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Lung Imaging: Selected Techniques (0581)	not covered	Sep 10, 2026	payer document
Capital Blue Cross	Experimental and Investigational Procedures (MP 4.002) Procedure codes: Respiratory	listed, no stance	Sep 1, 2026	payer document
Cigna	Category III Current Procedural Terminology (CPT®) codes (0558)	unproven / investigational	Sep 15, 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
Premera Blue Cross	Non-covered Experimental/Investigational Services Page \| 11 of 38 \| ∞	listed, no stance	Oct 1, 2026	payer document
Regence	New and Emerging Medical Technologies and Procedures (Medicine 149) perianal perifistular soft tissue, \| Pharmaceuticals	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Category III Codes (2026T0644Q)	listed, no stance	Jul 1, 2026	payer document

Recent prior-auth changes

Aug 1, 2026: PA added, HealthSpring

Medicaid fee-for-service

Prior authorization required or conditional in IN.

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.

0807T CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0807T

Payer coverage policies that name 0807T

Recent prior-auth changes

Medicaid fee-for-service

`0807T` CPT® code: payer coverage and prior authorization