`36468` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 36468

59 of 59 payer prior-auth lists that name 36468 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Shield of California, 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 Illinois, 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, and others.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross Blue Shield of Arizona (AZ Blue)	AZ Blue-administered Medicare Advantage (M2K)	AZ	prior auth required		Sep 1, 2026	AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026)
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)
Blue Cross Blue Shield of Arizona (AZ Blue)	Standard PA code list (most commercial plans)	AZ	prior auth required		Sep 1, 2026	AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	State of Arizona employee group (SYD, S3Z)	AZ	prior auth required		Sep 1, 2026	State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)
Blue Shield of California	Blue Shield Medicare	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield Medicare
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
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	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	Vascular Interventions	All	prior auth required		Mar 7, 2026	Cigna Vascular Interventions Commercial Code List (title from file name)
Cigna	Vascular Interventions	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 Illinois	Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative)	IL	prior auth required		Jan 1, 2025	Procedure Code List, Effective 1/1/2025
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	KY	prior auth required		Jan 1, 2027	please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.
Humana	Humana Healthy Horizons	LA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate
Humana	Humana Healthy Horizons	OH	prior auth required		Jan 1, 2027	555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list
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
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 Complete Care (Virginia)	Medicaid	VA	prior auth required		Apr 1, 2025	Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
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 California	Medicaid	CA	prior auth required		Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
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	Medicaid	ID	prior auth required		Jan 1, 2025	Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
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 Illinois	Medicaid	IL	prior auth required		Jan 1, 2022	Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of Iowa	Medicaid	IA	prior auth required		Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023
Molina Healthcare of Michigan	Medicare Advantage	MI	prior auth required		Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
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 Michigan	Medicaid	MI	prior auth required		Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Mississippi	Medicaid	MS	prior auth required		Jan 1, 2025	Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
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 New Mexico	Medicaid	NM	prior auth required		Jul 1, 2026	New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026
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	STAR	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19
Molina Healthcare of Texas	STAR+PLUS	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19
Molina Healthcare of Texas	STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix)	TX	prior auth required		Jul 1, 2026	Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3
Molina Healthcare of Texas	Exchange	TX	prior auth required		Sep 1, 2019	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 Utah	Medicaid	UT	prior auth required		Jan 1, 2025	Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
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
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth required		Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
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
UnitedHealthcare Community Plan	Massachusetts Senior Care Options (SCO) and OneCare	MA	prior auth required		Oct 1, 2026	Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026
UnitedHealthcare Community Plan	New Mexico Turquoise Care	NM	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026
UnitedHealthcare Community Plan	Pennsylvania CHIP	PA	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026

Payer coverage policies that name 36468

36468 appears in 26 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, Capital Blue Cross, Premera Blue Cross, Regence, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Anesthetic and Antiemetic Infusion Pumps (0607)	listed, no stance (range 33016-37799)	Sep 9, 2026	payer document
Aetna	Bupivacaine Liposome (Exparel) (0941)	listed, no stance (range 33010-37799)	Jul 30, 2026	payer document
Aetna	Cardiovascular Ultrafiltration (0741)	listed, no stance (range 33010-37790)	Oct 30, 2025	payer document
Aetna	Negative Pressure Wound Therapy (0334)	listed, no stance (range 33016-37799)	Jun 8, 2026	payer document
Aetna	Nitric Oxide, Inhalational (INO) (0518)	not covered (range 33016-37790)	Jul 2, 2026	payer document
Aetna	Prolotherapy and Sclerotherapy (0207)	covered if criteria are met	Mar 27, 2026	payer document
Aetna	Stereolithographic Models and Implants (0613)	listed, no stance (range 33010-37790)	Sep 3, 2026	payer document
Aetna	Varicose Veins (0050)	not covered	Aug 3, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Treatment Of Varicose Veinsvenous Insufficiency (A.7.01.124)	unproven / investigational		payer document
Blue Cross Blue Shield of Massachusetts	Treatment of Varicous Veins and Venous Insufficiency (238)	not covered		payer document
Blue Cross NC	Varicose Veins of the Lower Extremities, Treatment for	listed, no stance	Nov 1, 2025	payer document
Blue Shield of California	Treatment of Varicose Veins/Venous Insufficiency (7.01.124)	listed, no stance		payer document
Capital Blue Cross	Treatment of Varicose Veins - Venous Insufficiency (MP 1.061) Procedure codes	unproven / investigational	Jun 1, 2026	payer document
Premera Blue Cross	Cosmetic and Reconstructive Services Page \| 9 of 20 \| ∞	listed, no stance	Apr 1, 2026	payer document
Premera Blue Cross	Treatment of Varicose Veins/Venous Insufficiency (7.01.519)	listed, no stance	Jul 13, 2026	payer document
Regence	Varicose Vein Treatment (Surgery 104) Notes	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (2026T0447SS)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (CS117.AC)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (for Idaho Only) (CS117ID.C)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (for Kansas Only) (CS117KS.03)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (for Kentucky Only) (CS117KY.12)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (for Nebraska Only) (CS117NE.AD)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (for New Mexico Only) (CS117NM.D)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (for Ohio Only) (CS117OH.E)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (for Pennsylvania Only) (CS117PA.AA)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Surgical and Ablative Procedures for Venous Insufficiency and Varicose Veins (for Tennessee Only) (CS117TN.AA)	listed, no stance	Aug 1, 2026	payer document

Recent prior-auth changes

Jan 1, 2026: PA removed, Blue Cross and Blue Shield of Illinois
Jan 1, 2026: PA removed, Blue Cross and Blue Shield of Illinois
Jun 1, 2025: PA removed, UnitedHealthcare Community Plan
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, FL, IN, WA.

AZ: $250.73 (outpatient_hospital), effective Oct 1, 2021
CO: $53.88 (health_first_colorado), effective Jul 1, 2026
FL: $32.52 (physician, non-facility), effective Jan 1, 2026
KY: $0.00 (asc), effective Jan 1, 2026
LA: $8.60 (professional), effective Feb 1, 2013
MA: $0.00 (asc), effective May 1, 2026
ND: $0.00 (physician), effective Aug 1, 2026
NE: $66.68 (physician, non-facility), effective Jul 1, 2026
NY: $21.96 (physician_surgery, facility), effective Jul 1, 2026
VA: $136.14 (medical), effective Jul 1, 2009
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $179.77 (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.

36468 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 36468

Payer coverage policies that name 36468

Recent prior-auth changes

Medicaid fee-for-service

`36468` CPT® code: payer coverage and prior authorization