`0922T` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0922T

12 of 12 payer prior-auth lists that name 0922T require prior authorization or set conditions: CarePlus Health Plans, Humana.

Payer	Plan	State	Prior auth	Since	Source
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 0922T

0922T appears in 8 coverage policies from Aetna, Anthem, Blue Shield of California, 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	\| Vagus Nerve Stimulation (7.01.20)	listed, no stance		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®) 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 \| 15 of 38 \| ∞	listed, no stance	Oct 1, 2026	payer document
Regence	New and Emerging Medical Technologies and Procedures (Medicine 149) contractility modulation-defibrillation \| CCM-D System	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Category III Codes (2026T0644Q)	listed, no stance	Jul 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

KY: $2042.30 (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.

0922T CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0922T

Payer coverage policies that name 0922T

Medicaid fee-for-service

`0922T` CPT® code: payer coverage and prior authorization