Payer policies › CPT 0826T0826T CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 0826T 14 of 14 payer prior-auth lists that name 0826T require prior authorization or set conditions: CarePlus Health Plans, HealthSpring, Humana.
Payer Plan State Prior auth Conditions Since Source HealthSpring Medicare Advantage All prior auth required Aug 1, 2026 2026 Q4 Prior Authorization List CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services Humana Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services Humana Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Payer coverage policies that name 0826T 0826T appears in 6 coverage policies from Aetna, Blue Cross NC, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), 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 NC Leadless Cardiac Pacemakers listed, no stance Jun 1, 2026 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®) CodesCPT 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 UnitedHealthcare Category III CPT Codes (MMP043.49)atrial, including imaging guidance | (20.8.4) listed, no stance Sep 1, 2026 payer 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.
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.