Payer policies › CPT 0933T0933T CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 0933T 19 of 19 payer prior-auth lists that name 0933T require prior authorization or set conditions: CarePlus Health Plans, Cigna, HealthSpring, Humana.
Payer Plan State Prior auth Conditions Since Source Cigna ACA/IFP All prior auth required May be delegated to eviCore for some clients Jan 1, 2025 Master Precertification List (For Health Care Providers) Cigna Basic Standard All prior auth required May be delegated to eviCore for some clients Jan 1, 2025 Master Precertification List (For Health Care Providers) Cigna Complete/PHS+/Preferred All prior auth required May be delegated to eviCore for some clients Jan 1, 2025 Master Precertification List (For Health Care Providers) Cigna Other Services All prior auth required Experimental/investigational Mar 7, 2026 Cigna Commercial Prior Authorization Procedure Code List: Other Services Cigna Other Services All prior auth required Experimental/investigational Mar 7, 2026 Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs 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 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 0933T 0933T appears in 11 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Blue Shield of California, Capital Blue Cross, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Implantable Left Atrial Hemodynamic Monitor (0832) not covered Dec 9, 2025 payer document Anthem Implantable Devices for Remote Monitoring of Heart Failure (SURG.00166) unproven / investigational Aug 13, 2026 payer document Blue Cross & Blue Shield of Mississippi Cardiac Hemodynamic Monitoring For The Management Of Heart Failure In The Outpatient Setting unproven / investigational payer document Blue Cross NC Cardiac Monitoring Devices in the Outpatient Setting listed, no stance Oct 1, 2025 payer document Blue Shield of California Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting (2.02.24) listed, no stance payer document Capital Blue Cross Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting (MP 2.051)Procedure Codes unproven / investigational Sep 1, 2026 payer document Cigna Cardiac Omnibus Codes (0574) unproven / investigational Sep 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 | 16 of 38 | ∞ listed, no stance Oct 1, 2026 payer document Regence New and Emerging Medical Technologies and Procedures (Medicine 149)an echocardiogram that demonstrated | based support 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: $2112.13 (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.