`0850T` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0850T

Payer coverage policies that name 0850T

0850T appears in 2 coverage policies from Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	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 Services and Procedures Page \| 6 of 30 \| ∞	listed, no stance	Jun 1, 2026	payer document

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.

0850T CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0850T

Payer coverage policies that name 0850T

Medicaid fee-for-service

`0850T` CPT® code: payer coverage and prior authorization