43285 CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 43285 require prior authorization or set conditions: Rocky Mountain Health Plans.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| 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 |
43285 appears in 8 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Gastroesophageal Reflux Disease (GERD) (0213) | not covered | Jul 21, 2026 | payer document |
| Anthem | Lower Esophageal Sphincter Augmentation Devices (SURG.00131) | unproven / investigational | Nov 6, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | Magnetic Esophageal Sphincter Augmentation To Treat Gastroesophageal Reflux Disease (A.7.01.137) | unproven / investigational | payer document | |
| Blue Cross NC | Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease (GERD) | listed, no stance | Nov 1, 2025 | payer document |
| Blue Shield of California | Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease (7.01.137) | listed, no stance | payer document | |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Lower Esophageal Magnetic Sphincter Augmentation (SUR709.036) | listed, no stance | Jan 1, 2026 | payer document |
| Premera Blue Cross | Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease (7.01.137) | listed, no stance | Jan 12, 2026 | payer document |
| Regence | Magnetic Esophageal Ring to Treat Gastroesophageal Reflux Disease (GERD) (Surgery 190) | listed, no stance | Mar 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.