0863T CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 0863T 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 |
0863T appears in 7 coverage policies from Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Blue Cross & Blue Shield of Mississippi | Biventricular Pacemakers Cardiac Resynchronization Therapy For The Treatment Of Heart Failure | unproven / investigational | payer document | |
| Blue Cross Blue Shield of Massachusetts | Biventricular pacemakers (101) | unproven / investigational | 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 | |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure (MED202.054) CPT Codes 33202, 33203, 33207, 33208, 33211, 33213, 33214, 33217, 33220, | listed, no stance | Oct 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 |
| Regence | New and Emerging Medical Technologies and Procedures (Medicine 149) perianal perifistular soft tissue, | Pharmaceuticals | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Omnibus Codes (MMP107.09) component only | Commercial Medical | listed, no stance | Jun 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.