0969T CPT® code: payer coverage and prior authorization9 of 9 payer prior-auth lists that name 0969T require prior authorization or set conditions: CarePlus Health Plans, HealthSpring, Humana.
0969T appears in 7 coverage policies from Aetna, Blue Shield of California, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Epilepsy Surgery (0394) | not covered | Jun 23, 2026 | payer document |
| Blue Shield of California | Responsive Neurostimulation for the Treatment of Refractory Focal Epilepsy (7.01.143) | listed, no stance | payer document | |
| Capital Blue Cross | Experimental and Investigational Procedures (MP 4.002) Procedure codes: Miscellaneous | listed, no stance | Sep 1, 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 | 18 of 38 | ∞ | listed, no stance | Oct 1, 2026 | payer document |
| Regence | Responsive Neurostimulation (Surgery 216) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Category III Codes (2026T0644Q) | 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.