0964T CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 0964T 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 |
0964T appears in 14 coverage policies from Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Blue Shield of California | Medical Management of Obstructive Sleep Apnea Syndrome (8.01.67) | listed, no stance | 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 |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Medical Management of Sleep Related Breathing Disorders (MED204.006) | listed, no stance | May 15, 2026 | payer document |
| Premera Blue Cross | Non-covered Experimental/Investigational Services Page | 18 of 38 | ∞ | listed, no stance | Oct 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (CS116.AM) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (2026T0525UU) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Kansas Only) (CS116KS.03) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Kentucky Only) (CS116KY.16) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Nebraska Only) (CS116NE.AI) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for New Mexico Only) (CS116NM.E) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for North Carolina Only) (CSNCT0525.12) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Ohio Only) (CS116OH.G) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Pennsylvania Only) (CS116PA.AL) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Tennessee Only) (CS116TN.AN) | 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.