0867T CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 0867T 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 |
0867T appears in 15 coverage policies from Aetna, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Benign Prostatic Hyperplasia (0079) | not covered | Apr 15, 2026 | payer document |
| Capital Blue Cross | Experimental and Investigational Procedures (MP 4.002) Procedure codes: Genitourinary | listed, no stance | Sep 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 |
| Premera Blue Cross | Non-covered Experimental/Investigational Services Page | 12 of 38 | ∞ | listed, no stance | Oct 1, 2026 | payer document |
| Regence | Benign Prostatic Hyperplasia Surgical Treatments (Surgery 210) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Category III CPT Codes (MMP043.49) cavernosum, low energy | UnitedHealthcare | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (2026T0618P) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (CS334.H) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Kansas Only) (CS334KS.02) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Kentucky Only) (CS334KY.12) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Nebraska Only) (CS334NE.I) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for New Mexico Only) (CS334NM.D) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Ohio Only) (CS334OH.E) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Pennsylvania Only) (CS334PA.H) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Tennessee Only) (CS334TN.H) | listed, no stance | Jul 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.