23700 CPT® code: payer coverage and prior authorization27 of 28 payer prior-auth lists that name 23700 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Texas, Cigna, HealthSpring, 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 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, Molina Healthcare of Wisconsin, Molina Healthcare, Inc. (national grid), and others.
| 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 | Jan 1, 2016 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2016 | Master Precertification List (For Health Care Providers) |
| Cigna | Musculoskeletal | All | prior auth required | Mar 7, 2026 | Cigna Commercial Prior Authorization Procedure Code List: Musculoskeletal - Joint Surgery | |
| Cigna | Musculoskeletal | All | prior auth required | 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 | Jan 1, 2024 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
| HealthSpring | Medicare Advantage | All | prior auth required | Jan 1, 2025 | 2026 Q4 Prior Authorization List | |
| Molina Complete Care (Virginia) | Medicare-only PA matrix for D-SNP | VA | prior auth required | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022 | |
| Molina Healthcare of Arizona | Medicare-only PA matrix for D-SNP | AZ | prior auth required | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022 | |
| Molina Healthcare of California | Medicare Advantage | CA | prior auth required | Jul 1, 2021 | Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021 | |
| Molina Healthcare of Florida | Medicare Advantage | FL | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021 | |
| Molina Healthcare of Idaho | Medicare Advantage | ID | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021 | |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Molina Healthcare of Michigan | Exchange | MI | prior auth required | Jul 1, 2021 | Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 | |
| Molina Healthcare of Nevada | Medicaid | NV | prior auth required | Oct 1, 2022 | Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 | |
| Molina Healthcare of New Mexico | Medicare Advantage | NM | prior auth required | Jan 1, 2021 | Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021 | |
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Medicare and MyCare Ohio (MMP) Medicare | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Exchange | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of South Carolina | Medicare Advantage | SC | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021 | |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Jan 1, 2021 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 | |
| Molina Healthcare of Utah | Medicare Advantage | UT | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021 | |
| Molina Healthcare of Washington | Medicare Advantage | WA | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021 | |
| Molina Healthcare of Wisconsin | Medicare Advantage | WI | prior auth required | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021 | |
| Molina Healthcare, Inc. (national grid) | Molina national (MHI) Medicare grid | All | prior auth required | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021 | |
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | site of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WI | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth under conditions | site of care: outpatient hospital | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 |
23700 appears in 23 coverage policies from Aetna, Blue Shield of California, BlueCross BlueShield of South Carolina, Cigna, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Continuous Passive Motion (CPM) Machines (0010) | listed, no stance (range 23000-23921) | Mar 5, 2026 | payer document |
| Aetna | Infusion Pumps (0161) | listed, no stance (range 23000-23921) | Mar 31, 2026 | payer document |
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | not covered (range 23000-23929) | Jun 19, 2026 | payer document |
| Aetna | Manipulation Under General Anesthesia (0204) | covered if criteria are met | Mar 25, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | listed, no stance (range 23000-23929) | Jul 23, 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 Shield of California | | Manipulation Under Anesthesia (8.01.40) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Shoulder Arthroscopy (CAM 774) | listed, no stance | Sep 1, 2026 | payer document |
| Cigna | Manipulation Under Anesthesia (0276) | covered if criteria are met | Sep 15, 2026 | payer document |
| Cigna | Manipulation Under Anesthesia (0276) | not covered | Sep 15, 2026 | payer document |
| Regence | Manipulation Under Anesthesia (Medicine 130) | listed, no stance | Oct 1, 2025 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (CS075.U) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (2026T0515CC) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (for Idaho Only) (CS075ID.C) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (for Kansas Only) (CS075KS.02) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (for Kentucky Only) (CS075KY.07) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (for Nebraska Only) (CS075NE.U) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (for New Jersey Only) (CS075NJ.P) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (for New Mexico Only) (CS075NM.C) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (for North Carolina Only) (CSNCT0515.04) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (for Ohio Only) (CS075OH.D) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (for Pennsylvania Only) (CS075PA.R) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Manipulation Under Anesthesia (for Tennessee Only) (CS075TN.R) | listed, no stance | Mar 1, 2026 | payer document |
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.