11406 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 11406

2 of 2 payer prior-auth lists that name 11406 require prior authorization or set conditions: Neighborhood Health Partnership, UnitedHealthcare.

PayerPlanStatePrior authConditionsSinceSource
Neighborhood Health PartnershipNeighborhood Health PartnershipFLprior auth under conditionssite of care: outpatient hospital, ASC; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WISep 1, 2026Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth under conditionssite of care: outpatient hospital, ASCSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026

Payer coverage policies that name 11406

11406 appears in 11 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Centene, Regence, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaActinic Keratoses Treatments (0567)covered if criteria are metAug 21, 2026payer document
AetnaBenign Skin Lesion Removal (0633)covered if criteria are met (range 11400-11446)Sep 9, 2026payer document
AetnaCosmetic Surgery and Procedures (0031)covered if criteria are met (range 11400-11446)Jun 25, 2026payer document
AetnaLymphangioma and Infantile Hemangioma (0817)covered if criteria are met (range 11400-11446)Dec 3, 2025payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 10040-19499)Jul 29, 2026payer document
AnthemTreatment of Keloids and Scar Revision (CG-SURG-31)covered if criteria are met (range 11400-11446)May 14, 2026payer document
Blue Cross & Blue Shield of MississippiRemoval Of Benign Skin Lesions And Scars (L.7.01.412)covered if criteria are metpayer document
Blue Cross Blue Shield of MassachusettsBenign Skin Lesions (707)covered if criteria are metpayer document
CenteneCosmetic and Reconstructive Procedures Reference Number: CP.MP.31 (CP.MP.31)covered if criteria are metAug 1, 2026payer document
RegenceSurgical Site of Care – Hospital Outpatient (Utilization Management 19)listed, no stanceMay 1, 2026payer document
UnitedHealthcareOffice-Based Procedures – Site of Service (MP.12.22)
Dermatology
listed, no stanceJul 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, Oxford Health Plans
  • Sep 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, Neighborhood Health Partnership

Medicaid fee-for-service

Prior authorization required or conditional in WA.

  • AZ: $450.44 (asc), effective Oct 1, 2026
  • CO: $225.84 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $317.43 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IL: $170.77 (practitioner), effective Apr 1, 2024
  • IN: $191.25 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $250.00 (asc, facility), effective Aug 1, 1982
  • KY: $724.34 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $489.93 (asc), effective May 1, 2026
  • MS: $566.62 (comprehensive, facility), effective Oct 1, 2025
  • ND: $427.00 (physician, facility), effective Aug 1, 2026
  • NE: $552.00 (asc), effective Jul 1, 2024
  • NY: $104.47 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $126.49 (physician, facility), effective Jan 1, 2024
  • OK: $660.83 (asc), effective Jan 1, 2026
  • TX: $486.45 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $197.34 (medical, facility), effective Jul 1, 2026
  • VT: $1282.40 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $308.28 (asc), effective Jul 1, 2026
  • WY: $730.40 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.