11901 CPT® code: payer coverage and prior authorization11901 appears in 9 coverage policies from Aetna, Blue Shield of California.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Alopecia Areata (0423) | covered if criteria are met | Jul 10, 2026 | payer document |
| Aetna | Dermabrasion, Chemical Peels, and Acne Surgery (0251) | covered if criteria are met | Apr 15, 2026 | payer document |
| Aetna | Erectile Dysfunction and Peyronie's Disease (0007) | not covered | Jul 29, 2026 | payer document |
| Aetna | Eyelid Surgery (0084) | listed, no stance (range 11900-11901) | Mar 3, 2026 | payer document |
| Aetna | Hypertrophic Scars and Keloids (0389) | covered if criteria are met | May 28, 2026 | payer document |
| Aetna | Lymphangioma and Infantile Hemangioma (0817) | covered if criteria are met (range 11900-11901) | Dec 3, 2025 | payer document |
| Aetna | Skin and Soft Tissue Substitutes (0244) | not covered (range 10040-19499) | Jul 29, 2026 | payer document |
| Aetna | Talimogene Laherparepvec (Imlygic) (0900) | covered if criteria are met | Apr 14, 2026 | payer document |
| Blue Shield of California | BSC7.08 | Cosmetic and Reconstructive Procedures | listed, no stance | payer document |
Prior authorization required or conditional in WV.
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.