21060 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 21060

8 of 8 payer prior-auth lists that name 21060 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Cigna, Humana.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)Federal Employee Program (FEP)AZprior auth requiredSep 1, 2026Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)
AetnaCommercialAllprior auth requiredOct 1, 2026Participating provider precertification list for Aetna®
AetnaMedicare AdvantageAllprior auth requiredOct 1, 2026Participating provider precertification list for Aetna®
CignaACA/IFPAllprior auth requiredMay be delegated to eviCore for some clientsOct 1, 2006Master Precertification List (For Health Care Providers)
CignaComplete/PHS+/PreferredAllprior auth requiredMay be delegated to eviCore for some clientsOct 1, 2006Master Precertification List (For Health Care Providers)
CignaOther ServicesAllprior auth requiredMar 7, 2026Cigna Commercial Prior Authorization Procedure Code List: Other Services
CignaOther ServicesAllprior auth requiredMar 7, 2026Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
HumanaHumana Healthy HorizonsINprior auth requiredJan 1, 20271 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a

Payer coverage policies that name 21060

21060 appears in 23 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaDental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans (0082)covered if criteria are metMar 18, 2026payer document
AetnaGeneral Anesthesia and Monitored Anesthesia Care for Oral and Maxillofacial Surgery and Dental Services (0124)covered if criteria are met (range 21034-21116)Mar 19, 2026payer document
AetnaRemote Ischemic Conditioning (0814)listed, no stance (range 20000-29999)Nov 20, 2025payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 20100-29999)Jul 29, 2026payer document
AetnaTemporomandibular Disorders (0028)covered if criteria are metMar 12, 2026payer document
AnthemTemporomandibular Disorders (CG-SURG-09)covered if criteria are metNov 6, 2025payer document
Blue Cross & Blue Shield of MississippiTemporomandibular Joint Disordercovered if criteria are metpayer document
Blue Cross Blue Shield of MassachusettsTemporomandibular joint disorder (035)listed, no stancepayer document
Blue Cross NCTemporomandibular Joint Dysfunction (TMJD)listed, no stanceOct 1, 2025payer document
BlueCross BlueShield of South CarolinaTemporomandibular Joint Dysfunction (CAM 20121)listed, no stanceAug 1, 2026payer document
CignaTemporomandibular Joint (TMJ) Disorder Surgery (0156)covered if criteria are metDec 15, 2025payer document
Premera Blue CrossTemporomandibular Joint Disorder (2.01.535)listed, no stanceApr 13, 2026payer document
UnitedHealthcareTreatment of Temporomandibular Joint Disorders (CS195.J)listed, no stanceJun 1, 2026payer document
UnitedHealthcareTreatment of Temporomandibular Joint Disorders (2026T0079RR)listed, no stanceMar 1, 2026payer document
UnitedHealthcareTreatment of Temporomandibular Joint Disorders (for Idaho Only) (CS195ID.C)listed, no stanceJul 1, 2026payer document
UnitedHealthcareTreatment of Temporomandibular Joint Disorders (for Kansas Only) (CS195KS.02)listed, no stanceJun 1, 2026payer document
UnitedHealthcareTreatment of Temporomandibular Joint Disorders (for Kentucky Only) (CS195KY.10)listed, no stanceJun 1, 2026payer document
UnitedHealthcareTreatment of Temporomandibular Joint Disorders (for Nebraska Only) (CS195NE.J)listed, no stanceJun 1, 2026payer document
UnitedHealthcareTreatment of Temporomandibular Joint Disorders (for New Jersey Only) (CS195NJ.G)listed, no stanceJun 1, 2026payer document
UnitedHealthcareTreatment of Temporomandibular Joint Disorders (for North Carolina Only) (CSNCT0079.08)listed, no stanceJun 1, 2026payer document
UnitedHealthcareTreatment of Temporomandibular Joint Disorders (for Ohio Only) (CS195OH.E)listed, no stanceJul 1, 2026payer document
UnitedHealthcareTreatment of Temporomandibular Joint Disorders (for Pennsylvania Only) (CS195PA.H)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTreatment of Temporomandibular Joint Disorders (for Tennessee Only) (CS195TN.H)listed, no stanceJun 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Jul 1, 2026: PA removed, UnitedHealthcare
  • Jul 1, 2026: PA removed, Surest
  • Jul 1, 2026: PA removed, UnitedHealthcare
  • Jul 1, 2026: PA removed, Neighborhood Health Partnership
  • Jul 1, 2026: PA removed, UnitedHealthcare
  • Jul 1, 2026: PA removed, Oxford Health Plans
  • Jun 1, 2026: PA removed, UnitedHealthcare
  • Jun 1, 2026: PA removed, UnitedHealthcare Community Plan
  • Jun 1, 2026: PA removed, UnitedHealthcare

Medicaid fee-for-service

Prior authorization required or conditional in WA, WV.

  • AZ: $1943.46 (asc), effective Oct 1, 2026
  • CO: $649.74 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $557.99 (physician, non-facility), effective Jan 1, 2026
  • IL: $524.68 (practitioner), effective Apr 1, 2024
  • IN: $608.68 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $483.26 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $2953.46 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $1909.57 (asc), effective May 1, 2026
  • MS: $2333.88 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1741.07 (physician, facility), effective Aug 1, 2026
  • NE: $1233.00 (asc), effective Jul 1, 2024
  • NY: $377.16 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $568.62 (physician), effective Jan 1, 2000
  • OK: $2694.50 (asc), effective Jan 1, 2026
  • TX: $1954.22 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $621.53 (medical), effective Jul 1, 2026
  • VT: $4596.52 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $366.60 (asc), effective Jul 1, 2026
  • WY: $2617.97 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.