20985 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 20985

2 of 2 payer prior-auth lists that name 20985 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)Federal Employee Program (FEP)AZprior auth under conditionsFEP Blue Focus onlySep 1, 2026Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)
UnitedHealthcare Community PlanUnitedHealthcare Connected (Texas MMP)TXprior auth requiredJan 1, 2015Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U

Payer coverage policies that name 20985

20985 appears in 24 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, BlueCross BlueShield of South Carolina, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaBrachial Plexus Surgery (0850)not coveredDec 18, 2025payer document
AetnaHip Arthroplasty (0287)not coveredSep 23, 2026payer document
AetnaKnee Arthroplasty (0660)not coveredOct 8, 2026payer document
AetnaRemote Ischemic Conditioning (0814)listed, no stance (range 20000-29999)Nov 20, 2025payer document
AetnaShoulder Arthroplasty and Arthrodesis (0837)not coveredJun 25, 2026payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 20100-29999)Jul 29, 2026payer document
Blue Cross & Blue Shield of MississippiComputerassisted Navigation For Orthopedic Procedureunproven / investigationalpayer document
Blue Cross Blue Shield of MassachusettsComputer-Assisted Navigation Orthopedic Procedure (594)unproven / investigationalpayer document
Blue Cross NCComputer Assisted Surgical Navigational Orthopedic Procedureslisted, no stanceJun 1, 2026payer document
BlueCross BlueShield of South CarolinaComputer-Assisted Navigation for Orthopedic Procedure (CAM 70196)listed, no stanceFeb 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Computer-Assisted Navigation for Orthopedic Procedures (SUR705.023)listed, no stanceSep 1, 2026payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (2026T0599L)listed, no stanceFeb 1, 2026payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (CS167.J)listed, no stanceApr 1, 2026payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (for Idaho Only) (CS167ID.B)listed, no stanceJun 1, 2026payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (for Kansas Only) (CS167KS.02)listed, no stanceApr 1, 2026payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (for Kentucky Only) (CS167KY.06)listed, no stanceApr 1, 2026payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (for Nebraska Only) (CS167NE.J)listed, no stanceApr 1, 2026payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (for New Jersey Only) (CS167NJ.G)listed, no stanceApr 1, 2026payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (for New Mexico Only) (CS167NM.C)listed, no stanceApr 1, 2026payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (for North Carolina Only) (CSNCT0599.04)listed, no stanceApr 1, 2026payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (for Ohio Only) (CS167OH.D)listed, no stanceJan 1, 2025payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (for Pennsylvania Only) (CS167PA.H)listed, no stanceApr 1, 2026payer document
UnitedHealthcareComputer-Assisted Surgical Navigation for Musculoskeletal Procedures (for Tennessee Only) (CS167TN.H)listed, no stanceApr 1, 2026payer document
UnitedHealthcareOrthopedic Procedures, Devices, and Products (MMP068.11)
Computer-Assisted Surgical Navigation for Musculoskeletal Procedures		listed, no stanceSep 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, Oxford Health Plans
  • Apr 1, 2026: PA removed, Blue Cross and Blue Shield of New Mexico
  • Apr 1, 2026: PA removed, Blue Cross and Blue Shield of New Mexico

Medicaid fee-for-service

  • CO: $113.54 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $99.50 (physician, non-facility), effective Jan 1, 2026
  • IL: $100.42 (practitioner), effective Apr 1, 2024
  • IN: $109.00 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $87.22 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $119.79 (professional), effective Feb 1, 2013
  • MA: $0.00 (asc), effective May 1, 2026
  • MS: $104.38 (comprehensive), effective Jul 1, 2026
  • ND: $128.04 (physician), effective Aug 1, 2026
  • NE: $207.48 (physician, non-facility), effective Jul 1, 2026
  • OH: $97.42 (physician), effective Jan 1, 2024
  • OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
  • VA: $107.35 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

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.