11980 CPT® code: payer coverage and prior authorization10 of 10 payer prior-auth lists that name 11980 require prior authorization or set conditions: Cigna, UnitedHealthcare, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Cigna | ACA/IFP | All | prior auth required | Aug 25, 2017 | Master Precertification List (For Health Care Providers) | |
| Cigna | Basic Standard | All | prior auth required | Aug 25, 2017 | Master Precertification List (For Health Care Providers) | |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | Aug 25, 2017 | Master Precertification List (For Health Care Providers) | |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | 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 Complete Effective September 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 | North Carolina Medicaid | NC | prior auth under conditions | only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890 | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of North Carolina Effective October 1, 2026 July 1, 2024 |
| 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 Community Plan of Kentucky | KY | 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 Kentucky Effective July 1, 2026 |
| UnitedHealthcare Community Plan | Virginia Cardinal Care LTSS | VA | prior auth required | Oct 1, 2026 | Prior authorization requirements for Virginia Cardinal Care LTSS Effective October 1, 2026 |
11980 appears in 15 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, BlueCross BlueShield of South Carolina, Capital Blue Cross, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Female Sexual Dysfunction (FSD) (0574) | listed, no stance | Sep 10, 2026 | payer document |
| Aetna | Gender Affirming Surgery (0615) | listed, no stance | Sep 8, 2026 | payer document |
| Aetna | Gonadotropin-Releasing Hormone Analogs and Antagonists (0501) | covered if criteria are met | Jul 10, 2026 | payer document |
| Aetna | Implantable Hormone Pellets (0345) | covered if criteria are met | Jul 8, 2026 | payer document |
| Aetna | Skin and Soft Tissue Substitutes (0244) | not covered (range 10040-19499) | Jul 29, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Hormone Pellet Implantation For Hormone Replacement Therapy Hrt In Women (L.5.01.500) | covered if criteria are met | payer document | |
| Blue Cross NC | Hormone Pellet Implantation for Treatment of Menopause Related Symptoms | listed, no stance | Mar 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Implantable Hormone Pellets for Females (CAM 019) | listed, no stance | Apr 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Testosterone Replacement Therapies (CAM 50123) | listed, no stance | Apr 1, 2026 | payer document |
| Capital Blue Cross | Subcutaneous Hormone Pellet Implants (MP 2.345) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Subcutaneous Hormone Pellet Implants (MP 2.345) Procedure Codes | unproven / investigational | Sep 1, 2026 | payer document |
| Cigna | Compounded Medications (IP0251) | unproven / investigational | Dec 15, 2025 | payer document |
| Cigna | Testosterone (Injectable) Products (IP0351) | covered if criteria are met | Dec 15, 2025 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Hormone Replacement Therapies (RX501.007) | listed, no stance | Oct 1, 2026 | payer document |
| UnitedHealthcare | Testosterone Replacement or Supplementation Therapy (CS2026D0076Q) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Testosterone Replacement or Supplementation Therapy (2026D0076J) | listed, no stance | Jan 1, 2026 | payer document |
Prior authorization required or conditional in WA, 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.