43257 CPT® code: payer coverage and prior authorization8 of 8 payer prior-auth lists that name 43257 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Cigna, Rocky Mountain Health Plans, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | Standard PA code list (most commercial plans) | AZ | prior auth under conditions | place of service 19, 21, 22; site of care: hospital (not ASC) | Sep 1, 2026 | AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026) |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Oct 1, 2006 | Master Precertification List (For Health Care Providers) |
| Cigna | Basic Standard | All | prior auth required | May be delegated to eviCore for some clients | Oct 1, 2006 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Oct 1, 2006 | Master Precertification List (For Health Care Providers) |
| Cigna | Other Services | All | prior auth required | Experimental/investigational | Mar 7, 2026 | Cigna Commercial Prior Authorization Procedure Code List: Other Services |
| Cigna | Other Services | All | prior auth required | Experimental/investigational | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs |
| 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 Community Plan | UnitedHealthcare Connected (Texas MMP) | TX | prior auth required | Jan 1, 2015 | Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U |
43257 appears in 27 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Centene, Cigna, Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Gastroesophageal Reflux Disease (GERD) (0213) | not covered | Jul 21, 2026 | payer document |
| Aetna | Lung Transplantation (0598) | not covered | Sep 8, 2026 | payer document |
| Aetna | Risankizumab-rzaa (Skyrizi) (1009) | listed, no stance (range 43233-43259) | Jul 1, 2026 | payer document |
| Aetna | Upper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (0738) | covered if criteria are met (range 43233-43270) | Oct 29, 2025 | payer document |
| Anthem | Transendoscopic Therapy for Gastroesophageal Reflux Disease, Dysphagia, or Gastroparesis (CG-SURG-132) | not covered | Feb 19, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Endoscopic Radiofrequency Ablation Or Cryoablation For Barrett Esophagus | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Transesophageal Endoscopic Therapies For Gastroesophageal Reflux Disease | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Transesophageal Endoscopic Treatments for Gastroesophageal Reflux Disease | not covered | May 20, 2026 | payer document |
| Blue Cross Blue Shield of Massachusetts | Surgical and Transesophageal Endoscopic Procedures to Treat Gastroesophageal Reflux Disease (920) | unproven / investigational | payer document | |
| Blue Cross NC | Gastroesophageal Reflux Disease, Transendoscopic Therapies | listed, no stance | Mar 1, 2026 | payer document |
| Blue Shield of California | Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease (2.01.38) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease (CAM 20138) | listed, no stance | Sep 1, 2026 | payer document |
| Centene | Anesthesiology Services for Gastrointestinal Endoscopy (CP.MP.161) | covered if criteria are met | May 1, 2019 | payer document |
| Cigna | Minimally Invasive Anti-Reflux Procedures and Peroral Endoscopic Myotomy (POEM) Procedures (0019) | unproven / investigational | Sep 15, 2026 | payer document |
| Premera Blue Cross | Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease (2.01.38) | listed, no stance | Feb 9, 2026 | payer document |
| Regence | Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease (GERD) (Surgery 110) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (CS079.U) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (2026T0322MM) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (for Idaho Only) (CS079ID.C) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (for Kansas Only) (CS079KS.03) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (for Kentucky Only) (CS079KY.13) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (for Nebraska Only) (CS079NE.U) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (for New Jersey Only) (CS079NJ.Q) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (for New Mexico Only) (CS079NM.D) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (for Ohio Only) (CS079OH.E) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (for Pennsylvania Only) (CS079PA.U) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Minimally Invasive Procedures for the Treatment of Upper Gastrointestinal Diseases (for Tennessee Only) (CS079TN.V) | listed, no stance | Aug 1, 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.