20611 CPT® code: payer coverage and prior authorization2 of 2 payer prior-auth lists that name 20611 require prior authorization or set conditions: Neighborhood Health Partnership, UnitedHealthcare.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | site of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WI | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth under conditions | site of care: outpatient hospital | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 |
20611 appears in 18 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, BlueCross BlueShield of South Carolina, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Etanercept (0315) CD11c expression and DNA methylation as biomarkers of etanercept response | listed, no stance (range 20600-20611) | Jul 8, 2026 | payer document |
| Aetna | Knee Arthroscopy / Osteoarthritis of the Knee (0673) | listed, no stance | Feb 19, 2026 | payer document |
| Aetna | Prolotherapy and Sclerotherapy (0207) | listed, no stance (range 20600-20611) | Mar 27, 2026 | payer document |
| Aetna | Remote Ischemic Conditioning (0814) | listed, no stance (range 20000-29999) | Nov 20, 2025 | payer document |
| Aetna | Skin and Soft Tissue Substitutes (0244) | not covered (range 20100-29999) | Jul 29, 2026 | payer document |
| Aetna | Temporomandibular Disorders (0028) | covered if criteria are met | Mar 12, 2026 | payer document |
| Aetna | Ultrasound Guidance – Selected Indications (0952) | covered if criteria are met | Apr 27, 2026 | payer document |
| Aetna | Viscosupplementation (0179) | not covered | Sep 2, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Intraarticular Hyaluronan Injections For Osteoarthritis (S.2.01.422) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Intraarticular Hyaluronan Injections For Osteoarthritis (L.2.01.422) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Trigger Point Injections (L.2.01.405) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Intra-Articular Hyaluronan Injections for Osteoarthritis | not covered | Feb 1, 2016 | payer document |
| Blue Cross NC | Temporomandibular Joint Dysfunction (TMJD) | listed, no stance | Oct 1, 2025 | payer document |
| BlueCross BlueShield of South Carolina | Intra-Articular Hyaluronan Injections for Osteoarthritis (CAM 20131) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Sodium Hyaluronate (2026D0081L) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Sodium Hyaluronate (CS2026D0081P) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Sodium Hyaluronate (for Indiana Only) (CSIND0081.05) | listed, no stance | Jul 1, 2025 | payer document |
| UnitedHealthcare | Sodium Hyaluronate (for Ohio Only) (CSOH2025D0081.C) | listed, no stance | Sep 1, 2025 | 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.