20939 CPT® code: payer coverage and prior authorization21 of 21 payer prior-auth lists that name 20939 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Texas, Cigna, Neighborhood Health Partnership, Oxford Health Plans, Surest, UnitedHealthcare, 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 | FEP Blue Focus only | Sep 1, 2026 | Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Aug 23, 2019 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Aug 23, 2019 | Master Precertification List (For Health Care Providers) |
| Cigna | Musculoskeletal | All | prior auth under conditions | Add-on code: requested with the primary procedure | Mar 7, 2026 | Cigna Commercial Prior Authorization Procedure Code List: Musculoskeletal - Spine Surgery |
| Cigna | Musculoskeletal | All | prior auth under conditions | Add-on code: requested with the primary procedure | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs |
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jul 1, 2026 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth required | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 | |
| Oxford Health Plans | Oxford Health Plans | All | prior auth required | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 | |
| Surest | Surest health plans | All | prior auth required | Oct 1, 2026 | Prior Authorization Requirements for Surest Effective October 1, 2026 | |
| UnitedHealthcare | Preferred Care Network and Preferred Care Partners of Florida | FL | prior auth required | Oct 1, 2026 | Prior authorization requirements for Preferred Care Network and Preferred Care Partners of Florida Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Commercial | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth required | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Medicare Advantage, Peoples Health and Dual Complete (D-SNP) | All | prior auth required | Excluded plans: Erickson Advantage | Oct 1, 2026 | UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Mid-Atlantic Health Plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare West commercial plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare of the River Valley | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | Minnesota Metro Medicaid | MN | prior auth required | Oct 1, 2024 | Prior authorization requirements for Minnesota Medicaid Effective October 1, 2024 | |
| UnitedHealthcare Community Plan | North Carolina Medicaid | NC | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of North Carolina Effective October 1, 2026 July 1, 2024 | |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Kentucky | KY | prior auth required | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026 | |
| UnitedHealthcare Community Plan | UnitedHealthcare Connected (Texas MMP) | TX | prior auth required | Jul 1, 2021 | Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U |
20939 appears in 25 coverage policies from Aetna, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Molina Healthcare, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Bone and Tendon Graft Substitutes and Adjuncts (0411) | listed, no stance | Aug 18, 2026 | payer document |
| Aetna | Distraction Osteogenesis for Craniofacial Defects (0549) | listed, no stance | Jul 30, 2026 | payer document |
| Aetna | Dry Eyes (0457) | not covered | Jul 29, 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 |
| Blue Cross NC | Orthopedic Applications of Stem Cell Therapy | listed, no stance | Feb 1, 2026 | payer document |
| Blue Shield of California | Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used with Autologous Bone Marrow) (8.01.52) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Percutaneous Treatment of Fracture Non-Unions or Bone Defects with Autologous Bone Marrow with or without Demineralized Bone Matrix (DBM) (CAM 20175) | listed, no stance | May 1, 2026 | payer document |
| Molina Healthcare | Stem Cell Therapy for Orthopedic Applications Policy No. 426 (426) | listed, no stance | Oct 8, 2025 | payer document |
| Regence | Cervical Spinal Fusion (Surgery 244) | listed, no stance | Mar 1, 2026 | payer document |
| Regence | Lumbar Spinal Fusion (Surgery 187) | listed, no stance | Mar 1, 2026 | payer document |
| Regence | Orthopedic Applications of Stem Cell Therapy, Including Bone Substitutes Used with Autologous Bone Marrow (Medicine 142) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (2026T0410KK) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (CS009.V) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (for Idaho Only) (CS009ID.D) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (for Kansas Only) (CS009KS.02) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (for Kentucky Only) (CS009KY.08) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (for Nebraska Only) (CS009NE.V) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (for New Jersey Only) (CS009NJ.S) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (for New Mexico Only) (CS009NM.C) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (for North Carolina Only) (CSNCT0410.05) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (for Ohio Only) (CS009OH.D) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (for Pennsylvania Only) (CS009PA.T) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Spinal Fusion and Bone Healing Enhancement Products (for Tennessee Only) (CS009TN.T) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Spine Procedures (MMP089.18) Spinal Fusion and Bone Healing Enhancement Products Including Allograft or Synthetic Bone Graft Materials | listed, no stance | Aug 1, 2026 | payer document |
Prior authorization required or conditional in NE.
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.