Payer policies › CPT 0915T0915T CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 0915T 13 of 13 payer prior-auth lists that name 0915T 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
Payer coverage policies that name 0915T 0915T appears in 9 coverage policies from Aetna, Anthem, Blue Shield of California, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Cardiac Contractility Modulation (CCM) Therapy (0930)Impulse Dynamics' Optimizer system not covered Mar 3, 2026 payer document Anthem Cardiac Contractility Modulation Therapy (SURG.00153) unproven / investigational Aug 13, 2026 payer document Blue Shield of California | Implantable Cardioverter Defibrillators (7.01.44) listed, no stance payer document Cigna Cardiac Omnibus Codes (0574) unproven / investigational Sep 15, 2026 payer document Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) Cardiac Contractility Modulation Device (MED202.068)CPT Codes 0408T, 0409T, 0410T, 0411T, 0412T, 0413T, 0414T, 0415T, 0416T, 0417T, listed, no stance Apr 15, 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 Premera Blue Cross Non-covered Experimental/Investigational ServicesPage | 15 of 38 | ∞ listed, no stance Oct 1, 2026 payer document Regence New and Emerging Medical Technologies and Procedures (Medicine 149)generated 12-lead ECG from a | system listed, no stance Jun 1, 2026 payer document UnitedHealthcare Category III Codes (2026T0644Q) listed, no stance Jul 1, 2026 payer document
Recent prior-auth changes Jul 1, 2026: PA added, HealthSpring Medicaid fee-for-service Prior authorization required or conditional in IN.
KY: $24317.77 (asc), effective Jan 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.