30150 CPT® code: payer coverage and prior authorization5 of 5 payer prior-auth lists that name 30150 require prior authorization or set conditions: Cigna.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Oct 1, 2006 | Master Precertification List (For Health Care Providers) |
| Cigna | Basic Standard | All | prior auth required | May be delegated to eviCore for some clients | Oct 1, 2006 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Oct 1, 2006 | Master Precertification List (For Health Care Providers) |
| Cigna | Other Services | All | prior auth required | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs | |
| Cigna | Other Services | All | prior auth required | Mar 7, 2026 | Cigna Commercial Prior Authorization Procedure Code List: Other Services |
30150 appears in 6 coverage policies from Aetna, Blue Cross NC, Cigna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Cosmetic Surgery and Procedures (0031) | covered if criteria are met | Jun 25, 2026 | payer document |
| Aetna | Obstructive Sleep Apnea in Adults (0004) | not covered (range 30150-31235) | Oct 6, 2026 | payer document |
| Aetna | Obstructive Sleep Apnea in Children (0752) | not covered (range 30000-30999) | Oct 30, 2025 | payer document |
| Aetna | Tezepelumab-ekko (Tezspire) (1003) | listed, no stance (range 30000-31299) | Aug 6, 2026 | payer document |
| Blue Cross NC | Professional Pathology Billing Requirements AHS – R2169 | listed, no stance (range 3011F-3210F) | Mar 1, 2024 | payer document |
| Cigna | Partial Rhinectomy, Rhinoplasty, Vestibular Stenosis Repair and Septoplasty (0119) | covered if criteria are met | Jul 1, 2026 | payer document |
Prior authorization required or conditional in CO, WV.
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.