43192 CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 43192 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| 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) |
43192 appears in 4 coverage policies from Aetna, Anthem.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Botulinum Toxin (0113) | covered if criteria are met | Jul 14, 2026 | payer document |
| Aetna | Upper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (0738) | covered if criteria are met (range 43191-43196) | Oct 29, 2025 | payer document |
| Aetna | Vocal Cord Paralysis / Insufficiency Treatments (0253) | covered if criteria are met | Apr 15, 2026 | payer document |
| Anthem | Transendoscopic Therapy for Gastroesophageal Reflux Disease, Dysphagia, or Gastroparesis (CG-SURG-132) | not covered | Feb 19, 2026 | payer document |
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.