38232 CPT® code: payer coverage and prior authorization107 of 107 payer prior-auth lists that name 38232 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, 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, 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) |
| Cigna | ACA/IFP | All | prior auth required | Jan 1, 2012 | Master Precertification List (For Health Care Providers) | |
| Cigna | Basic Standard | All | prior auth required | Jan 1, 2012 | Master Precertification List (For Health Care Providers) | |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | Jan 1, 2012 | 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 Healthy Horizons | VA | prior auth required | Jan 1, 2027 | Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) | |
| 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 | Medicare Advantage | ID | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Idaho), 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 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 | Medicaid | 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 | 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 | |
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | *Code will only require prior authorization for an oncology diagnosis | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| Oxford Health Plans | Oxford Health Plans | All | prior auth under conditions | *Code will only require prior authorization for an oncology diagnosis | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 |
| Rocky Mountain Health Plans | Rocky Mountain Health Plans CHP+ | CO | prior auth required | Oct 1, 2026 | Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 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 | |
| Surest | Surest health plans | All | prior auth required | Oct 1, 2026 | Prior Authorization Requirements for Surest Effective October 1, 2026 | |
| UnitedHealthcare | Preferred Care Network and Preferred Care Partners of Florida | FL | prior auth under conditions | *Code will only require prior authorization for an oncology diagnosis Unclassified codes** | Oct 1, 2026 | Prior authorization requirements for Preferred Care Network and Preferred Care Partners of Florida Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Commercial | All | prior auth under conditions | *Code will only require prior authorization for an oncology diagnosis. | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026 |
| 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 | UnitedHealthcare Medicare Advantage, Peoples Health and Dual Complete (D-SNP) | All | prior auth under conditions | *For unclassified code and | Oct 1, 2026 | UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Mid-Atlantic Health Plans | All | prior auth under conditions | *Code will only require prior authorization for an oncology diagnosis | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare West commercial plans | All | prior auth under conditions | *Code will only require prior authorization for an oncology diagnosis. | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare of the River Valley | All | prior auth under conditions | *Code will only require prior authorization for an oncology diagnosis | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026 |
| UnitedHealthcare Community Plan | AHCCCS Complete Care (ACC) | AZ | prior auth under conditions | *Code will only require prior authorization for an oncology diagnosis. | Oct 1, 2026 | Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026 |
| UnitedHealthcare Community Plan | ALTCS Developmentally Disabled | AZ | prior auth under conditions | *Code will only require prior authorization for an oncology diagnosis. | Oct 1, 2026 | Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026 |
| UnitedHealthcare Community Plan | ALTCS Long Term Care | AZ | prior auth under conditions | *Code will only require prior authorization for an oncology diagnosis | Oct 1, 2026 | Prior authorization requirements for Arizona Long Term Care 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 | KanCare | KS | prior auth under conditions | *For unclassified codes prior authorization is required for Casgevy, Omisirge | Oct 1, 2026 | Prior authorization requirements for Kansas Medicaid Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Louisiana Medicaid (Healthy Louisiana) | LA | prior auth under conditions | * Amtagvi, Lantidra, Skysona and Zevaskyn will require PA through Optum Transplant | Jan 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Louisiana |
| UnitedHealthcare Community Plan | Maryland HealthChoice | MD | prior auth under conditions | * Code will only require prior authorization for an oncology diagnosis. | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026 |
| UnitedHealthcare Community Plan | Massachusetts OneCare | MA | prior auth required | Nov 1, 2025 | Prior authorization requirements for Massachusetts OneCare Effective November 1, 2025 |
38232 appears in 133 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 | Acute Ischemic Stroke Treatments (0789) | not covered | Nov 19, 2025 | payer document |
| Aetna | Age-Related Macular Degeneration (0765) | not covered | Jan 14, 2026 | payer document |
| Aetna | Autism Spectrum Disorders (0648) | not covered | Oct 2, 2025 | payer document |
| Aetna | Blood and Adipose Tissue Derived Products for Selected Indications (0784) | not covered | Nov 19, 2025 | payer document |
| Aetna | Bone and Tendon Graft Substitutes and Adjuncts (0411) | not covered | Aug 18, 2026 | payer document |
| Aetna | Brentuximab Vedotin (Adcetris) (0823) | listed, no stance | Sep 24, 2026 | payer document |
| Aetna | Core Decompression for Avascular Necrosis (0753) | not covered | Oct 30, 2025 | payer document |
| Aetna | Diabetic Neuropathy: Selected Treatments (0729) | not covered | Feb 24, 2026 | payer document |
| Aetna | Dry Eyes (0457) | not covered | Jul 29, 2026 | payer document |
| Aetna | Epilepsy Surgery (0394) | not covered | Jun 23, 2026 | payer document |
| Aetna | Erythropoiesis Stimulating Agents (0195) | not covered (range 38204-38232) | Jan 20, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Aplastic Anemia and other Bone Marrow Failure Syndromes (0627) | not covered | 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 Chronic Myelogenous Leukemia (0674) | not covered | 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) | not covered | 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) | not covered | Dec 9, 2025 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Myelofibrosis (0838) | not covered | 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 Ovarian Cancer (0635) | covered if criteria are met | Sep 11, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Primary Immunodeficiency Disorders (0830) | not covered | 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 Thalassemia Major and Sickle Cell Anemia (0626) | not covered | Sep 18, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Waldenstrom Macroglobulinemia (0833) | covered if criteria are met | Dec 9, 2025 | payer document |
| Aetna | Huntington's Disease (0614) | not covered | Sep 24, 2026 | payer document |
| Aetna | Hypertrophic Scars and Keloids (0389) | not covered | May 28, 2026 | payer document |
| Aetna | Knee Arthroscopy / Osteoarthritis of the Knee (0673) Balneotherapy, Advanced Arthritis Relief Protocol, high-intensity laser therapy, pulsed vibration therapy, xeno-matrix-induced chondrogenesis - | not covered | Feb 19, 2026 | payer document |
| Aetna | Marnetegragene Autotemcel (Kresladi) (1102) | listed, no stance | Jul 13, 2026 | payer document |
| Aetna | Narsoplimab-wuug (Yartemlea) (1099) | listed, no stance | Apr 27, 2026 | payer document |
| Aetna | Neurogenic Bladder: Selected Treatments (0852) Peripheral lidocaine application (neural therapy), Genital nerve stimulation | not covered | Dec 23, 2025 | payer document |
| Aetna | Parenteral Immunoglobulins (0206) | listed, no stance | Oct 8, 2026 | payer document |
| Aetna | Parkinson's Disease (0307) | not covered | Feb 24, 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 | Pralatrexate (0740) | listed, no stance | Sep 10, 2026 | payer document |
| Aetna | Temporomandibular Disorders (0028) | not covered | Mar 12, 2026 | payer document |
| Aetna | Transmyocardial and Endovascular Laser Revascularization (0163) Adipose derived stromal cells | not covered | Mar 20, 2026 | payer document |
| Aetna | YAG Laser in Ophthalmology and Other Selected Indications (0354) | listed, no stance | May 21, 2026 | payer document |
| Anthem | Gene Therapy for Beta Thalassemia (MED.00140) | covered if criteria are met | Aug 13, 2026 | payer document |
| Anthem | Gene Therapy for Cerebral Adrenoleukodystrophy (MED.00142) | covered if criteria are met | May 14, 2026 | payer document |
| Anthem | Gene Therapy for Metachromatic Leukodystrophy (MED.00148) | covered if criteria are met | May 14, 2026 | payer document |
| Anthem | Gene Therapy for Severe Leukocyte Adhesion Deficiency-I (MED.00149) | covered if criteria are met | Aug 13, 2026 | payer document |
| Anthem | Gene Therapy for Sickle Cell Disease (MED.00146) | covered if criteria are met | Aug 13, 2026 | payer document |
| Anthem | Gene Therapy for Wiskott-Aldrich Syndrome (MED.00161) | covered if criteria are met | May 14, 2026 | payer document |
| Anthem | Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors (TRANS.00031) | covered if criteria are met | 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) | covered if criteria are met | 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) | unproven / investigational | 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 | Hematopoietic Cell Transplantation For Autoimmune Diseases | listed, no stance | 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 | 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 | 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 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 | 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 | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for CNS Embryonal Tumors and Ependymoma (MP 9.050) Procedure codes | covered if criteria are met | May 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma (MP 9.038) Procedure codes | unproven / investigational | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia (MP 9.039) Procedure codes | unproven / investigational | 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) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Primary Amyloidosis (MP 9.045) Procedure codes | covered if criteria are met | May 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation for Solid Tumors of Childhood (MP 9.054) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Capital Blue Cross | Hematopoietic Cell Transplantation in the Treatment of Germ-Cell Tumors (MP 9.052) Procedure Codes | covered if criteria are met | Sep 1, 2026 | payer document |
| Centene | Tandem Transplant (CP.MP.162) | covered if criteria are met | Jan 1, 2026 | payer document |
| Cigna | Bone Graft Substitutes (0118) | listed, no stance | Feb 15, 2026 | payer document |
| Cigna | Cell-Based Therapy for Cardiac and Peripheral Arterial Disease (0287) | unproven / investigational | May 15, 2026 | payer document |
| Cigna | Cell-Based Therapy for Cardiac and Peripheral Arterial Disease (0287) | not covered | May 15, 2026 | payer document |
| Cigna | Plantar Fasciitis Treatments (0097) | not covered | May 15, 2026 | payer document |
| Cigna | Stem Cell Transplantation: Blood Cancers (0533) | covered if criteria are met | Aug 15, 2026 | payer document |
| Cigna | Stem Cell Transplantation: Non-Cancer Disorders (0535) | covered if criteria are met | Jan 15, 2026 | payer document |
| Cigna | Stem Cell Transplantation: Solid Tumors (0534) | covered if criteria are met | Jan 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms (SUR703.032) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, | listed, no stance | May 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Hematopoietic Cell Transplantation for Acute Lymphoblastic Leukemia (SUR703.043) CPT Codes 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212, | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in IN, WA.
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.