`1091T` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 1091T

2 of 2 payer prior-auth lists that name 1091T require prior authorization or set conditions: Cigna.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Cigna	ACA/IFP	All	prior auth required	May be delegated to eviCore for some clients	Oct 1, 2026	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required	May be delegated to eviCore for some clients	Oct 1, 2026	Master Precertification List (For Health Care Providers)

Payer coverage policies that name 1091T

1091T appears in 3 coverage policies from Aetna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Skin and Soft Tissue Substitutes (0244)	not covered (range 10040-19499)	Jul 29, 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 \| 27 of 38 \| ∞	listed, no stance	Oct 1, 2026	payer document

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.

1091T CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 1091T

Payer coverage policies that name 1091T

`1091T` CPT® code: payer coverage and prior authorization