1017T CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 1017T

Payer coverage policies that name 1017T

1017T appears in 8 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.

PayerPolicyRole in policyReviewedDocument
AetnaGastroesophageal Reflux Disease (GERD) (0213)not coveredJul 21, 2026payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 10040-19499)Jul 29, 2026payer document
Blue Shield of CaliforniaBSC9.01 | Investigational Serviceslisted, no stancepayer document
Capital Blue CrossExperimental and Investigational Procedures (MP 4.002)
Procedure codes: Miscellaneous
listed, no stanceSep 1, 2026payer 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 stanceJan 1, 2027payer document
Premera Blue CrossNon-covered Experimental/Investigational Services
Page | 22 of 38 | ∞
listed, no stanceOct 1, 2026payer document
RegenceNew and Emerging Medical Technologies and Procedures (Medicine 149)
acoustic and electrocardiogram | technology
listed, no stanceJun 1, 2026payer document
UnitedHealthcareCategory III Codes (2026T0644Q)listed, no stanceJul 1, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • ND: $0.00 (physician), effective Aug 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Apr 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.