42836 CPT® code: payer coverage and prior authorization42836 appears in 11 coverage policies from Aetna, Anthem, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Capital Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Enuresis (0431) | not covered | Jul 1, 2026 | payer document |
| Aetna | Myringotomy and Tympanostomy Tube (0418) | listed, no stance (range 42830-42836) | Jun 30, 2026 | payer document |
| Aetna | Obstructive Sleep Apnea in Adults (0004) | covered if criteria are met | Oct 6, 2026 | payer document |
| Aetna | Obstructive Sleep Apnea in Children (0752) | covered if criteria are met (range 42835-42836) | Oct 30, 2025 | payer document |
| Aetna | Obstructive Sleep Apnea in Children (0752) | listed, no stance (range 42700-42999) | Oct 30, 2025 | payer document |
| Aetna | Sinus Surgeries (0937) | listed, no stance | Apr 10, 2026 | payer document |
| Anthem | Adenoidectomy (CG-SURG-36) | covered if criteria are met | Feb 19, 2026 | payer document |
| Blue Cross Blue Shield of Massachusetts | Surgical treatment of Snoring and Obstructive Sleep Apnea Syndrome (130) | listed, no stance | payer document | |
| Blue Cross NC | Surgery for Obstructive Sleep Apnea and Upper Airway Resistance Syndrome | listed, no stance | Mar 1, 2026 | payer document |
| Blue Shield of California | Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome (7.01.101) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome (CAM 701101) 21685 | Hyoid myotomy and suspension | listed, no stance (range 42835-42836) | Jul 1, 2026 | payer document |
| Capital Blue Cross | Surgical Treatment of Sleep Apnea and Snoring (MP 1.128) Procedure codes | covered if criteria are met | Apr 1, 2026 | payer document |
Prior authorization required or conditional in 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.