`38230` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 38230

81 of 81 payer prior-auth lists that name 38230 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Cross and Blue Shield of Texas, Blue Shield of California, Blue Shield of California Promise Health Plan, 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, 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 Standard and Basic only	Sep 1, 2026	Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 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
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California Promise Health Plan	Promise Health Plan Medi-Cal	CA	prior auth required		Sep 1, 2026	Medi-Cal Prior Authorization List
Cigna	ACA/IFP	All	prior auth required		Oct 1, 2006	Master Precertification List (For Health Care Providers)
Cigna	Basic Standard	All	prior auth required		Oct 1, 2006	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required		Oct 1, 2006	Master Precertification List (For Health Care Providers)
Blue Cross and Blue Shield of Illinois	Blue Cross Community Health Plans (BCCHP), Illinois Medicaid	IL	prior auth required		Jan 1, 2026	Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026
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
Blue Cross and Blue Shield of New Mexico	Turquoise Care (New Mexico Medicaid)	NM	prior auth required		Oct 1, 2026	New Mexico Medicaid Benefit Preauthorization Procedure Code List 10/1/26
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Jul 1, 2026	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
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	FL	prior auth required		Jan 1, 2027	1102002FL1026 FLHN8CBEN Humana Healthy Horizons in Florida Preauthorization and Notification List
Humana	Humana Healthy Horizons	IL	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Illinois Prior Authorization and Notification List To view -specific medical coverage policies, please visit Humana Healthy Horizons in Illinois Clinical coverage policies .
Humana	Humana Healthy Horizons	IN	prior auth required		Jan 1, 2027	1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a
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 Healthy Horizons	OK	prior auth required		Jan 1, 2027	Humana Healthy Horizons® in Oklahoma Prior Authorization Notification List (PAL) The following preauthorization and notification list
Humana	Humana Healthy Horizons	SC	prior auth required		Jan 1, 2027	Humana Healthy Horizons in South Carolina Prior authorization and Notification List The following list describes services and medications that are commonly reviewed and may require additional clinical
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
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	Medicaid	CA	prior auth required		Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
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	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		Apr 1, 2023	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	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 Michigan	Medicare Advantage	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	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 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
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 Health Plans Prime / RAE	CO	prior auth required		Oct 1, 2026	Rocky Mountain Health Plans PRIME Effective October 1, 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	UnitedHealthcare Complete (Individual & Family plans)	All	prior auth required		Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcare	UnitedHealthcare Individual Exchange plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Individual Exchange plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcare Community Plan	Indiana Hoosier Care Connect	IN	prior auth required		Oct 1, 2026	Prior authorization requirements for Indiana Hoosier Care Connect Effective October 1, 2026
UnitedHealthcare Community Plan	Indiana PathWays for Aging (MLTSS)	IN	prior auth required		Oct 1, 2026	Prior authorization requirements for Indiana MLTSS Pathways Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Kentucky	KY	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026

Payer coverage policies that name 38230

38230 appears in 143 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Capital Blue Cross, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Molina Healthcare, Premera Blue Cross, Regence.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Autism Spectrum Disorders (0648)	not covered	Oct 2, 2025	payer document
Aetna	Brentuximab Vedotin (Adcetris) (0823)	listed, no stance	Sep 24, 2026	payer document
Aetna	Core Decompression for Avascular Necrosis (0753)	listed, no stance	Oct 30, 2025	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	Extracorporeal Photochemotherapy (Photopheresis) (0241)	listed, no stance (range 38204-38230)	Apr 13, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Aplastic Anemia and other Bone Marrow Failure Syndromes (0627)	covered if criteria are met	Sep 23, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Autoimmune Diseases and Miscellaneous Indications (0606)	not covered (range 38230-38232)	Sep 18, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Breast Cancer (0507)	not covered	Aug 6, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Chronic Myelogenous Leukemia (0674)	covered if criteria are met	Oct 7, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Hodgkin's Disease (0495)	covered if criteria are met	Jul 2, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Inherited Metabolic Disorders and Genetic Diseases (0871)	covered if criteria are met	Dec 22, 2025	payer document
Aetna	Hematopoietic Cell Transplantation for Multiple Myeloma (0497)	covered if criteria are met	Aug 5, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Myelodysplastic Syndrome (0836)	covered if criteria are met	Dec 9, 2025	payer document
Aetna	Hematopoietic Cell Transplantation for Myelofibrosis (0838)	covered if criteria are met	Dec 9, 2025	payer document
Aetna	Hematopoietic Cell Transplantation for Non-Hodgkin's Lymphoma (0494)	covered if criteria are met	Aug 3, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Primary Immunodeficiency Disorders (0830)	covered if criteria are met	Dec 9, 2025	payer document
Aetna	Hematopoietic Cell Transplantation for Selected Childhood Solid Tumors (0496)	covered if criteria are met	Aug 6, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Selected Leukemias (0640)	covered if criteria are met	Sep 11, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Solid Tumors in Adults (0811)	not covered	Dec 3, 2025	payer document
Aetna	Hematopoietic Cell Transplantation for Testicular Cancer (0617)	covered if criteria are met (range 38206-38230)	Sep 3, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Testicular Cancer (0617)	not covered	Sep 3, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Thalassemia Major and Sickle Cell Anemia (0626)	covered if criteria are met	Sep 18, 2026	payer document
Aetna	Hematopoietic Cell Transplantation for Waldenstrom Macroglobulinemia (0833)	not covered	Dec 9, 2025	payer document
Aetna	Huntington's Disease (0614)	not covered	Sep 24, 2026	payer document
Aetna	Hypoxic Ischemic Encephalopathy (0812)	not covered	Nov 20, 2025	payer document
Aetna	Marnetegragene Autotemcel (Kresladi) (1102)	listed, no stance	Jul 13, 2026	payer document
Aetna	Multiple Sclerosis (0264)	not covered	Sep 10, 2026	payer document
Aetna	Narsoplimab-wuug (Yartemlea) (1099)	listed, no stance	Apr 27, 2026	payer document
Aetna	Non-myeloablative Hematopoietic Cell Transplantation (Mini-Allograft / Reduced Intensity Conditioning Transplant) (0634)	covered if criteria are met	Sep 25, 2026	payer document
Aetna	Parenteral Immunoglobulins (0206)	listed, no stance	Oct 8, 2026	payer document
Aetna	Pegzilarginase-nbln (Loargys) (1101)	listed, no stance	Jun 26, 2026	payer document
Aetna	Plerixafor (0779)	listed, no stance	Feb 13, 2026	payer document
Aetna	Stem Cells for Hematopoietic Cell Transplant (0190)	covered if criteria are met	Mar 27, 2026	payer document
Aetna	Temporomandibular Disorders (0028)	not covered	Mar 12, 2026	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors (TRANS.00031)	unproven / investigational	May 14, 2026	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Diabetes Mellitus (TRANS.00034)	unproven / investigational	Nov 6, 2025	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias (TRANS.00029)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Germ Cell Tumors (TRANS.00030)	unproven / investigational	Nov 6, 2025	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Hodgkin Disease and non-Hodgkin Lymphoma (TRANS.00028)	covered if criteria are met	May 14, 2026	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Multiple Myeloma and Other Plasma Cell Dyscrasias (TRANS.00023)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Pediatric Solid Tumors (TRANS.00027)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Hematopoietic Stem Cell Transplantation for Select Leukemias and Myelodysplastic Syndrome (TRANS.00024)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Therapeutic use of Stem Cells, Blood and Bone Marrow Products (TRANS.00035)	unproven / investigational	May 14, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Allogeneic Hematopoietic Cell Transplantation For Genetic Diseases And Acquired Anemias (L.8.01.412)	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Allogeneic Hematopoietic Cell Transplantation For Myelodysplastic Syndromes And Myeloproliferative Neoplasms	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Autologous Hematopoietic Stemcell Transplantation For Malignant Astrocytomas And Gliomas (L.8.01.405)	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Acute Lymphoblastic Leukemia	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Acute Myeloid Leukemia	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Autoimmune Diseases	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Chronic Lymphocytic Leukemiasmall Lymphocytic Lymphoma	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Chronic Myeloid Leukemia	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Cns Embryonal Tumors And Ependymoma	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Epithelial Ovarian Cancer	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Hodgkin Lymphoma	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Miscellaneous Solid Tumors In Adults	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Nonhodgkin Lymphomas	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Plasma Cell Dyscrasias Including Multiple Myeloma And Poems Syndrome	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Primary Amyloidosis Or Waldenstroms Macroglobulinemia	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation For Solid Tumors Of Childhood	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Cell Transplantation In The Treatment Of Germ Cell Tumors	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Hematopoietic Stemcell Transplantation For Breast Cancer (L.8.01.410)	not covered		payer document
Blue Cross & Blue Shield of Mississippi	Nonmyeloablative Allogeneic Transplants Of Hematopoietic Stemcells For Treatment Of Malignancy (L.8.01.406)	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Orthopedic Applications Of Stem Cell Therapy Including Allografts And Bone Substitutes Used With Autologous Bone Marrow	unproven / investigational		payer document
Blue Cross NC	Cord Blood as a Source of Stem Cells	listed, no stance	Mar 1, 2026	payer document
Blue Cross NC	Hematopoietic Cell Transplantation	listed, no stance	Mar 1, 2026	payer document
Blue Cross NC	Orthopedic Applications of Stem Cell Therapy	listed, no stance	Feb 1, 2026	payer document
Blue Shield of California	Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms (8.01.21)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (8.01.32)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (8.01.26)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Autoimmune Diseases (8.01.25)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma (8.01.28)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (8.01.15)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia (8.01.30)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (8.01.23)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Hodgkin Lymphoma (8.01.29)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas (8.01.20)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (8.01.17)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Primary Amyloidosis (8.01.42)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation for Solid Tumors of Childhood (8.01.34)	listed, no stance		payer document
Blue Shield of California	Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors (8.01.35)	listed, no stance		payer document
BlueCross BlueShield of South Carolina	Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms (CAM 80121)	listed, no stance	Jul 1, 2026	payer document
BlueCross BlueShield of South Carolina	Hematopoietic Cell Transplantation for Breast Cancer (CAM 80127)	listed, no stance	Jul 1, 2026	payer document
BlueCross BlueShield of South Carolina	Hematopoietic Cell Transplantation for Central Nervous System Embryonal Tumors and Ependymoma (CAM 80128) 38215 \| cell concentration in plasma, mononuclear, or buffy coat layer	listed, no stance	Jul 1, 2026	payer document
BlueCross BlueShield of South Carolina	Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (CAM 80123)	listed, no stance	Jul 1, 2026	payer document
BlueCross BlueShield of South Carolina	Hematopoietic Stem-Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (CAM 80117)	listed, no stance	Jan 1, 2026	payer document
Capital Blue Cross	Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms (MP 9.056) Procedure codes	covered if criteria are met	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (MP 9.041) Procedure codes	covered if criteria are met	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Acute Myeloid Leukemia (MP 9.040) Procedure codes	covered if criteria are met	May 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Autoimmune diseases (MP 9.053) Procedure codes	unproven / investigational	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for CNS Embryonal Tumors and Ependymoma (MP 9.050) Procedure codes	unproven / investigational	May 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma (MP 9.038) Procedure codes	covered if criteria are met	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia (MP 9.039) Procedure codes	covered if criteria are met	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer (MP 9.047) Procedure codes	unproven / investigational	May 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Hodgkin Lymphoma (MP 9.043) Procedure codes	covered if criteria are met	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (MP 9.048) Procedure codes	unproven / investigational	May 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas (MP 9.042) Procedure Codes	covered if criteria are met	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and Poems Syndrome (MP 9.044)	unproven / investigational	Sep 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Primary Amyloidosis (MP 9.045) Procedure codes	unproven / investigational	May 1, 2026	payer document
Capital Blue Cross	Hematopoietic Cell Transplantation for Solid Tumors of Childhood (MP 9.054) Procedure Codes	unproven / investigational	Sep 1, 2026	payer document

Recent prior-auth changes

Sep 1, 2026: PA added, Blue Shield of California Promise Health Plan
Jul 1, 2026: PA added, Rocky Mountain Health Plans
Apr 1, 2026: PA removed, UnitedHealthcare Community Plan
Apr 1, 2026: conditions changed, Blue Cross and Blue Shield of Illinois
Jan 1, 2026: conditions changed, Blue Cross and Blue Shield of Illinois
Mar 1, 2025: PA removed, Rocky Mountain Health Plans
Mar 1, 2025: PA removed, Rocky Mountain Health Plans
Jan 1, 2025: conditions changed, UnitedHealthcare
Oct 1, 2024: conditions changed, Molina Healthcare of Texas
Oct 1, 2024: conditions changed, Molina Healthcare of Texas

Medicaid fee-for-service

Prior authorization required or conditional in IN, NE, WA.

AZ: $785.70 (asc), effective Oct 1, 2026
CO: $163.38 (chp_plus, non-facility), effective Jul 1, 2026
IL: $201.67 (practitioner), effective Apr 1, 2024
IN: $152.59 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
KS: $600.00 (asc, facility), effective Aug 1, 1982
KY: $834.37 (asc), effective Jan 1, 2026
LA: $245.95 (professional), effective Jan 1, 2003
MA: $568.49 (asc), effective May 1, 2026
ND: $491.86 (physician, facility), effective Aug 1, 2026
NE: $533.52 (physician, non-facility), effective Jul 1, 2026
NY: $157.45 (physician_surgery, facility), effective Jul 1, 2026
OH: $168.39 (physician), effective Sep 1, 2013
OK: $761.22 (asc), effective Jan 1, 2026
TX: $564.62 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
VA: $150.75 (medical), effective Jul 1, 2026
VT: $1209.28 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $100.14 (physician, facility), effective Jul 1, 2026
WY: $688.75 (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.

38230 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 38230

Payer coverage policies that name 38230

Recent prior-auth changes

Medicaid fee-for-service

`38230` CPT® code: payer coverage and prior authorization