38226 CPT® code: payer coverage and prior authorization32 of 32 payer prior-auth lists that name 38226 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, CarePlus Health Plans, Cigna, HealthSpring, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Molina Healthcare of New Mexico, Molina Healthcare of Texas, Passport by Molina Healthcare (Kentucky).
38226 appears in 31 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, BlueCross BlueShield of South Carolina, Cigna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Axicabtagene Ciloleucel (Yescarta) (0924) | listed, no stance | Oct 9, 2026 | payer document |
| Aetna | Brentuximab Vedotin (Adcetris) (0823) | listed, no stance | Sep 24, 2026 | payer document |
| Aetna | Brexucabtagene Autoleucel (Tecartus) (0980) | listed, no stance | Mar 13, 2026 | payer document |
| Aetna | Ciltacabtagene Autoleucel (Carvykti) (1007) | listed, no stance | Mar 13, 2026 | payer document |
| Aetna | Donor Lymphocyte Infusion (0638) | covered if criteria are met (range 38207-38230) | Sep 29, 2026 | payer document |
| Aetna | Erythropoiesis Stimulating Agents (0195) | not covered (range 38204-38232) | Jan 20, 2026 | payer document |
| Aetna | Etuvetidigene Autotemcel (Waskyra) (1097) | listed, no stance | Oct 5, 2026 | payer document |
| Aetna | Extracorporeal Photochemotherapy (Photopheresis) (0241) | listed, no stance (range 38204-38230) | Apr 13, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Testicular Cancer (0617) | covered if criteria are met (range 38206-38230) | Sep 3, 2026 | payer document |
| Aetna | Huntington's Disease (0614) | listed, no stance | Sep 24, 2026 | payer document |
| Aetna | Idecabtagene Vicleucel (Abecma) (0992) | listed, no stance | Dec 19, 2025 | payer document |
| Aetna | Lisocabtagene Maraleucel (Breyanzi) (0986) | listed, no stance | Sep 14, 2026 | payer document |
| Aetna | Obecabtagene Autoleucel (Aucatzyl) (1072) | listed, no stance (range 38225-38228) | Jan 27, 2026 | payer document |
| Aetna | Onasemnogene Abeparvovec (Zolgensma and Itvisma) (0953) | not covered | Aug 10, 2026 | payer document |
| Aetna | Parenteral Immunoglobulins (0206) | listed, no stance | Oct 8, 2026 | payer document |
| Aetna | Polatuzumab Vedotin-piiq (Polivy) (0955) | listed, no stance | Sep 17, 2026 | payer document |
| Aetna | Quantitative EEG (Brain Mapping) (0221) | listed, no stance | Apr 14, 2026 | payer document |
| Aetna | Tisagenlecleucel (Kymriah) (0920) | covered if criteria are met | Sep 11, 2026 | payer document |
| Aetna | Tocilizumab (0799) | listed, no stance | Jun 30, 2026 | payer document |
| Aetna | Vedolizumab (Entyvio) (0885) | listed, no stance | Jun 30, 2026 | payer document |
| Aetna | Vitiligo (0422) | not covered | Jul 16, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Chimeric Antigen Receptor Therapy For Leukemia And Lymphoma | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Chimeric Antigen Receptor (CAR) T-cell therapy for cancers Medicare Advantage Plans | listed, no stance | Aug 7, 2019 | payer document |
| BlueCross BlueShield of South Carolina | Aucatzyl (obecabtagene autoleucel) (CAM 938) | listed, no stance | Jul 1, 2026 | payer document |
| Cigna | Oncology (Injectable – CAR-T) – Abecma (IP0168) | covered if criteria are met | Apr 15, 2026 | payer document |
| Cigna | Oncology (Injectable – CAR-T) – Aucatzyl (IP0734) | covered if criteria are met | Feb 1, 2026 | payer document |
| Cigna | Oncology (Injectable – CAR-T) – Breyanzi (IP0130) | covered if criteria are met | Mar 1, 2026 | payer document |
| Cigna | Oncology (Injectable – CAR-T) – Carvykti | covered if criteria are met | payer document | |
| Cigna | Oncology (Injectable – CAR-T) – Kymriah (IP0197) | covered if criteria are met | Jun 1, 2026 | payer document |
| Cigna | Oncology (Injectable – CAR-T) – Tecartus (IP0199) | covered if criteria are met | Sep 15, 2026 | payer document |
| Cigna | Oncology (Injectable – CAR-T) – Tecartus (IP0199) | listed, no stance | Sep 15, 2026 | payer document |
| Cigna | Oncology (Injectable – CAR-T) – Yescarta (IP0198) | covered if criteria are met | Jun 1, 2026 | payer document |
Prior authorization required or conditional in IN, VA.
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.