11952 CPT® code: payer coverage and prior authorization25 of 25 payer prior-auth lists that name 11952 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Shield of California, Cigna, Molina Healthcare of Iowa, Oxford Health Plans, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | Federal Employee Program (FEP) | AZ | prior auth under conditions | Only gender dysphoria dx, members in treatment as of 1/1/26 | Sep 1, 2026 | Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) |
| Blue Shield of California | Blue Shield Medicare | CA | prior auth required | Sep 1, 2026 | Prior Authorization List for Blue Shield Medicare | |
| Blue Shield of California | Blue Shield commercial | CA | prior auth required | Sep 1, 2026 | Prior Authorization List for Blue Shield | |
| Blue Shield of California | Blue Shield commercial | CA | prior auth required | Sep 1, 2026 | Prior Authorization List for Blue Shield | |
| Aetna | Medicare Advantage | All | prior auth required | Aug 1, 2024 | Participating provider behavioral health precertification list for Aetna | |
| Aetna | Commercial | All | prior auth required | Oct 1, 2026 | Participating provider precertification list for Aetna® | |
| Aetna | Medicare Advantage | All | prior auth required | Oct 1, 2026 | Participating provider precertification list for Aetna® | |
| Aetna | Commercial | All | prior auth required | Aug 1, 2024 | Participating provider behavioral health precertification list for Aetna | |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Oct 1, 2006 | Master Precertification List (For Health Care Providers) |
| Cigna | Basic Standard | All | prior auth required | May be delegated to eviCore for some clients | Oct 1, 2006 | 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, 2006 | Master Precertification List (For Health Care Providers) |
| Cigna | Other Services | All | prior auth required | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs | |
| Cigna | Other Services | All | prior auth required | Mar 7, 2026 | Cigna Commercial Prior Authorization Procedure Code List: Other Services | |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community Health Plans (BCCHP), Illinois Medicaid | IL | prior auth required | Oct 1, 2026 | Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026 | |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative) | IL | prior auth required | Jan 1, 2025 | Procedure Code List, Effective 1/1/2025 | |
| Blue Cross and Blue Shield of New Mexico | Turquoise Care (New Mexico Medicaid) | NM | prior auth required | Oct 1, 2026 | New Mexico Medicaid Benefit Preauthorization Procedure Code List 10/1/26 | |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Oxford Health Plans | Oxford Health Plans | All | prior auth required | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | Maryland HealthChoice | MD | prior auth under conditions | only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890 | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026 |
| UnitedHealthcare Community Plan | Massachusetts OneCare | MA | prior auth required | Nov 1, 2025 | Prior authorization requirements for Massachusetts OneCare Effective November 1, 2025 | |
| UnitedHealthcare Community Plan | Massachusetts Senior Care Options (SCO) | MA | prior auth required | Nov 1, 2025 | CPT® is a registered trademark of the American Medical Association. Prior authorization requirements for Massachusetts Senior Care Options Effective November 1, 2025 | |
| UnitedHealthcare Community Plan | Massachusetts Senior Care Options (SCO) and OneCare | MA | prior auth required | Oct 1, 2026 | Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | Pennsylvania CHIP | PA | prior auth under conditions | only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890 | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026 |
| UnitedHealthcare Community Plan | Pennsylvania Medicaid | PA | prior auth under conditions | only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890 | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026 |
| UnitedHealthcare Community Plan | UnitedHealthcare Connected (Texas MMP) | TX | prior auth required | Jan 1, 2015 | Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U |
11952 appears in 43 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Capital Blue Cross, Cigna, Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Breast Reconstructive Surgery (0185) | covered if criteria are met (range 11950-11954) | Apr 22, 2026 | payer document |
| Aetna | Cosmetic Surgery and Procedures (0031) | covered if criteria are met (range 11950-11954) | Jun 25, 2026 | payer document |
| Aetna | Fecal Incontinence (0611) Mesenchymal stem cell injection, Pudendal nerve terminal motor latency testing, Graciloplasty, Magnetic anal sphincter augmentation | not covered (range 11950-11954) | Sep 23, 2026 | payer document |
| Aetna | Gender Affirming Surgery (0615) | not covered (range 11950-11954) | Sep 8, 2026 | payer document |
| Aetna | Skin and Soft Tissue Substitutes (0244) CPT not covered for indications listed in the CPB | not covered (range 11950-11954) | Jul 29, 2026 | payer document |
| Aetna | Skin and Soft Tissue Substitutes (0244) | not covered (range 10040-19499) | Jul 29, 2026 | payer document |
| Aetna | Urinary Incontinence (0223) | covered if criteria are met | Jul 16, 2026 | payer document |
| Anthem | Autologous Fat Grafting and Injectable Soft Tissue Fillers (CG-SURG-123) | covered if criteria are met (range 11950-11954) | Nov 6, 2025 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Gender Affirming Care MEDICAL COVERAGE POLICY | 4 | covered if criteria are met | Apr 1, 2026 | payer document |
| Blue Cross NC | Sex Trait Modification Procedures For Gender Affirming Care | listed, no stance | Apr 1, 2026 | payer document |
| Blue Shield of California | BSC7.02 | Gender Affirmation Surgery | listed, no stance | payer document | |
| Blue Shield of California | BSC7.08 | Cosmetic and Reconstructive Procedures | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Gender Affirmation Surgery and Hormone Therapy (CAM 373) | listed, no stance (range 11950-11954) | Jan 1, 2026 | payer document |
| Capital Blue Cross | Gender Affirming Surgery (MP 1.144) Procedure codes | covered if criteria are met | Apr 1, 2026 | payer document |
| Cigna | Breast Reconstruction Following Mastectomy or Lumpectomy (0178) | unproven / investigational | Apr 15, 2026 | payer document |
| Cigna | Gender Dysphoria Treatment (0266) | not covered | Sep 15, 2026 | payer document |
| Cigna | Injectable Fillers for Head and Neck Conditions (0511) | not covered | Jun 15, 2026 | payer document |
| Cigna | Scar Revision (0328) | not covered | Jun 15, 2026 | payer document |
| Premera Blue Cross | Adipose-Derived Stem Cells in Autologous Fat Grafting to the Breast (7.01.153) | listed, no stance | Mar 23, 2026 | payer document |
| Premera Blue Cross | Cosmetic and Reconstructive Services Page | 7 of 20 | ∞ | listed, no stance | Apr 1, 2026 | payer document |
| Premera Blue Cross | Gender Transition/Affirmation Surgery and Related Services (7.01.557) | listed, no stance | Jul 1, 2026 | payer document |
| Regence | Adipose-derived Stem Cell Enrichment in Autologous Fat Grafting to the Breast (Surgery 182) | listed, no stance | Dec 1, 2025 | payer document |
| Regence | Cosmetic and Reconstructive Procedures (Surgery 12) | listed, no stance | Jul 1, 2026 | payer document |
| Regence | Gender Affirming Interventions for Gender Dysphoria (Medicine 153) NOTES | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (CS027.AD) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (MMP022.16) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (MP.007.33) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (for Idaho Only) (CS027ID.C) The following codes may be Cosmetic; review is required to determine if considered Cosmetic or | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (for Kansas Only) (CS027KS.03) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (for Kentucky Only) (CS027KY.13) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (for Nebraska Only) (CS027NE.U) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (for New Mexico Only) (CS027NM.E) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (for North Carolina Only) (CSNC.MP.007.10) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (for Ohio Only) (CS027OH.E) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (for Pennsylvania Only) (CS027PA.AD) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Cosmetic and Reconstructive Procedures (for Tennessee Only) (CS027TN.AB) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (2026T0580U) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (CS145.T) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for Kansas Only) (CS145KS.02) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for New Mexico Only) (CS145NM.D) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for North Carolina Only) (CSNCT0145.04) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for Ohio Only) (CS145OH.C) | listed, no stance | Sep 1, 2024 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for Pennsylvania Only) (CS145PA.P) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria and Gender Reassignment Surgery (MMP365.14) Other Ancillary Services | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in CO, IN, NE, NY, VT.
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.