Payer policies › CPT 2108221082 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 21082 15 of 15 payer prior-auth lists that name 21082 require prior authorization or set conditions: CarePlus Health Plans, Cigna, Humana, Rocky Mountain Health Plans.
Payer Plan State Prior auth Conditions Since Source Cigna ACA/IFP All prior auth required Oct 25, 2019 Master Precertification List (For Health Care Providers) Cigna Complete/PHS+/Preferred All prior auth required Oct 25, 2019 Master Precertification List (For Health Care Providers) CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana Healthy Horizons IN prior auth required Jan 1, 2027 1 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 Humana Humana Healthy Horizons VA prior auth required Jan 1, 2027 Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management Rocky Mountain Health Plans Rocky Mountain Medicare Advantage D-SNP CO prior auth required Feb 1, 2025 Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
Payer coverage policies that name 21082 21082 appears in 19 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Cigna, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Dental Services and Oral and Maxillofacial Surgery: Coverage Under Medical Plans (0082) covered if criteria are met Mar 18, 2026 payer document Aetna Facial Prostheses, External (0620) covered if criteria are met Sep 3, 2026 payer document Aetna General Anesthesia and Monitored Anesthesia Care for Oral and Maxillofacial Surgery and Dental Services (0124) covered if criteria are met (range 21034-21116) Mar 19, 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 Stereolithographic Models and Implants (0613) listed, no stance (range 21076-21088) Sep 3, 2026 payer document Blue Cross & Blue Shield of Mississippi Prosthetics (L.1.04.401) covered if criteria are met payer document Cigna Intraoral Prostheses (0584) covered if criteria are met Aug 15, 2026 payer document UnitedHealthcare Orthognathic (Jaw) Surgery (MP.013.25) listed, no stance May 1, 2026 payer document UnitedHealthcare Orthognathic (Jaw) Surgery (CS088.X) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Orthognathic (Jaw) Surgery (for Idaho Only) (CS088ID.D) listed, no stance Jul 1, 2026 payer document UnitedHealthcare Orthognathic (Jaw) Surgery (for Kansas Only) (CS088KS.04) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Orthognathic (Jaw) Surgery (for Kentucky Only) (CS088KY.11) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Orthognathic (Jaw) Surgery (for Nebraska Only) (CS088NE.W) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Orthognathic (Jaw) Surgery (for New Jersey Only) (CS088NJ.W) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Orthognathic (Jaw) Surgery (for New Mexico Only) (CS088NM.C) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Orthognathic (Jaw) Surgery (for Ohio Only) (CS088OH.E) listed, no stance Jul 1, 2026 payer document UnitedHealthcare Orthognathic (Jaw) Surgery (for Pennsylvania Only) (CS088PA.W) listed, no stance Jul 1, 2026 payer document UnitedHealthcare Orthognathic (Jaw) Surgery (for Tennessee Only) (CS088TN.X) listed, no stance Jun 1, 2026 payer document
Recent prior-auth changes Jan 1, 2027: PA added, Humana Mar 1, 2025: PA removed, Rocky Mountain Health Plans Mar 1, 2025: PA removed, Rocky Mountain Health Plans Medicaid fee-for-service Prior authorization required or conditional in CO, VA, WA, WV, WY.
AZ: $406.63 (asc), effective Oct 1, 2026 CO: $1081.63 (chp_plus, non-facility), effective Jul 1, 2026 FL: $783.14 (physician, facility), effective Jan 1, 2026 IL: $817.64 (practitioner), effective Sep 8, 2014 IN: $884.35 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $907.88 (default), effective Aug 1, 2024 KY: $725.46 (asc), effective Jan 1, 2026 LA: $1177.85 (professional), effective Feb 1, 2013 MA: $607.08 (asc), effective May 1, 2026 ND: $717.56 (physician, facility), effective Aug 1, 2026 NE: $2241.22 (physician, facility), effective Jul 1, 2026 OH: $695.66 (physician, facility), effective Jan 1, 2024 OK: $889.84 (physician, facility), effective Jul 1, 2026 TX: $519.92 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $860.53 (medical, facility), effective Jul 1, 2026 VT: $2574.33 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $581.33 (physician, facility), effective Jul 1, 2026 WY: $1466.22 (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.