21243 CPT® code: payer coverage and prior authorization59 of 60 payer prior-auth lists that name 21243 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), CarePlus Health Plans, Cigna, Humana, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of South Carolina, Molina Healthcare of Texas, Molina Healthcare of Utah, Molina Healthcare of Washington, and others.
21243 appears in 29 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Continuous Passive Motion (CPM) Machines (0010) | listed, no stance (range 21240-21243) | Mar 5, 2026 | payer 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 | General Anesthesia and Monitored Anesthesia Care for Oral and Maxillofacial Surgery and Dental Services (0124) | covered if criteria are met (range 21141-21268) | Mar 19, 2026 | payer document |
| Aetna | Orthognathic Surgery (0095) | covered if criteria are met | Mar 18, 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 |
| Anthem | Temporomandibular Disorders (CG-SURG-09) | covered if criteria are met | Nov 6, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | Temporomandibular Joint Disorder | covered if criteria are met | payer document | |
| Blue Cross Blue Shield of Massachusetts | Temporomandibular joint disorder (035) | listed, no stance | payer document | |
| Blue Cross NC | Temporomandibular Joint Dysfunction (TMJD) | listed, no stance | Oct 1, 2025 | payer document |
| Blue Shield of California | | Temporomandibular Joint Disorder (2.01.21) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Temporomandibular Joint Dysfunction (CAM 20121) | listed, no stance (range 21240-21243) | Aug 1, 2026 | payer document |
| Cigna | Temporomandibular Joint (TMJ) Disorder Surgery (0156) | covered if criteria are met | Dec 15, 2025 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Temporomandibular Joint Disorders (SUR705.010) CPT Codes 20550, 20605, 20606, 21010, 21050, 21060, 21070, 21073, 21076, | listed, no stance | Jan 1, 2026 | payer document |
| Premera Blue Cross | Orthodontic Services for Treatment of Congenital Craniofacial Anomalies (9.02.500) | listed, no stance | Jun 22, 2026 | payer document |
| Premera Blue Cross | Orthognathic Surgery (9.02.501) Page | 6 of 19 | ∞ | listed, no stance | May 12, 2026 | payer document |
| Premera Blue Cross | Temporomandibular Joint Disorder (2.01.535) Page | 4 of 20 | ∞ | listed, no stance | Apr 13, 2026 | payer document |
| UnitedHealthcare | Treatment of Temporomandibular Joint Disorders (2026T0079RR) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Treatment of Temporomandibular Joint Disorders (CS195.J) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Treatment of Temporomandibular Joint Disorders (for Idaho Only) (CS195ID.C) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Treatment of Temporomandibular Joint Disorders (for Kansas Only) (CS195KS.02) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Treatment of Temporomandibular Joint Disorders (for Kentucky Only) (CS195KY.10) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Treatment of Temporomandibular Joint Disorders (for Nebraska Only) (CS195NE.J) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Treatment of Temporomandibular Joint Disorders (for New Jersey Only) (CS195NJ.G) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Treatment of Temporomandibular Joint Disorders (for North Carolina Only) (CSNCT0079.08) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Treatment of Temporomandibular Joint Disorders (for Ohio Only) (CS195OH.E) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Treatment of Temporomandibular Joint Disorders (for Pennsylvania Only) (CS195PA.H) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Treatment of Temporomandibular Joint Disorders (for Tennessee Only) (CS195TN.H) | listed, no stance | Jun 1, 2026 | payer document |
Prior authorization required or conditional in CO, ND, NE, VA, VT, WA, WV, WY.
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.