0868T CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0868T

7 of 8 payer prior-auth lists that name 0868T require prior authorization or set conditions: HealthSpring, Molina Complete Care (Virginia), Molina Healthcare of Idaho, Molina Healthcare of Mississippi, Molina Healthcare of Texas, Molina Healthcare of Utah.

PayerPlanStatePrior authConditionsSinceSource
HealthSpringMedicare AdvantageAllprior auth requiredAug 1, 20262026 Q4 Prior Authorization List
Molina Complete Care (Virginia)MedicaidVAprior auth requiredApr 1, 2025Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
Molina Healthcare of IdahoMedicaidIDprior auth requiredJan 1, 2025Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
Molina Healthcare of MississippiMedicaidMSprior auth requiredJan 1, 2025Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
Molina Healthcare of TexasSTARTXprior auth requiredFeb 19, 2025Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19
Molina Healthcare of TexasSTAR+PLUSTXprior auth requiredFeb 19, 2025Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19
Molina Healthcare of UtahMedicaidUTprior auth requiredJan 1, 2025Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025

Payer coverage policies that name 0868T

0868T 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.

PayerPolicyRole in policyReviewedDocument
AetnaGastrointestinal Function: Selected Tests (0396)not coveredJul 9, 2026payer document
Capital Blue CrossExperimental and Investigational Procedures (MP 4.002)
Procedure codes: Miscellaneous		listed, no stanceSep 1, 2026payer 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 stanceJan 1, 2027payer document
Premera Blue CrossNon-covered Experimental/Investigational Services
Page | 12 of 38 | ∞		listed, no stanceOct 1, 2026payer document
RegenceNew and Emerging Medical Technologies and Procedures (Medicine 149)
perianal perifistular soft tissue, | Pharmaceuticals		listed, no stanceJun 1, 2026payer document
UnitedHealthcareCategory III CPT Codes (MMP043.49)
volume greater or equal to 50mL | Commercial Medical		listed, no stanceSep 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (CS046.T)listed, no stanceJul 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (2026T0415II)listed, no stanceJun 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Kansas Only) (CS046KS.04)listed, no stanceJul 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Kentucky Only) (CS046KY.12)listed, no stanceJul 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Nebraska Only) (CS046NE.T)listed, no stanceJul 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for New Mexico Only) (CS046NM.E)listed, no stanceJul 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Ohio Only) (CS046OH.F)listed, no stanceAug 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Pennsylvania Only) (CS046PA.S)listed, no stanceSep 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Tennessee Only) (CS046TN.S)listed, no stanceJul 1, 2026payer document

Recent prior-auth changes

  • Aug 1, 2026: PA added, HealthSpring
  • Jul 1, 2026: PA removed, Molina Healthcare of Texas
  • Jan 1, 2026: PA removed, Passport by Molina Healthcare (Kentucky)
  • Jan 1, 2026: PA removed, Molina Healthcare of Illinois
  • Apr 1, 2025: PA added, Molina Complete Care (Virginia)
  • Feb 19, 2025: PA added, Molina Healthcare of Texas
  • Feb 19, 2025: PA added, Molina Healthcare of Texas
  • Jan 1, 2025: PA added, Molina Healthcare of Mississippi
  • Jan 1, 2025: PA added, Molina Healthcare of Texas
  • Oct 1, 2024: PA added, Molina Healthcare of Illinois

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • CO: $359.89 (health_first_colorado), effective Jul 1, 2026
  • 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.