43860 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 43860

45 of 45 payer prior-auth lists that name 43860 require prior authorization or set conditions: Blue Shield of California, Cigna, Neighborhood Health Partnership, Oxford Health Plans, Rocky Mountain Health Plans, Surest, UnitedHealthcare, UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
Blue Shield of CaliforniaBlue Shield MedicareCAprior auth requiredSep 1, 2026Prior Authorization List for Blue Shield Medicare
Blue Shield of CaliforniaBlue Shield commercialCAprior auth requiredSep 1, 2026Prior Authorization List for Blue Shield
CignaACA/IFPAllprior auth requiredJan 1, 2009Master Precertification List (For Health Care Providers)
CignaComplete/PHS+/PreferredAllprior auth requiredJan 1, 2009Master Precertification List (For Health Care Providers)
Neighborhood Health PartnershipNeighborhood Health PartnershipFLprior auth under conditionsonly with dx E66.01, E66.09, E66.1, E66.2, E66.3, E66.8Sep 1, 2026Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Oxford Health PlansOxford Health PlansAllprior auth under conditionsonly with dx E66.01, E66.09, E66.1, E66.2, E66.8, E66.9Oct 1, 2026Prior Authorization Requirements for Oxford Effective October 1, 2026
Rocky Mountain Health PlansRocky Mountain Health Plans CHP+COprior auth requiredOct 1, 2026Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026
Rocky Mountain Health PlansRocky Mountain Health Plans Prime / RAECOprior auth requiredOct 1, 2026Rocky Mountain Health Plans PRIME Effective October 1, 2026
SurestSurest health plansAllprior auth under conditionsonly with dx E66.01, E66.09, E66.1, E66.2, E66.3, E66.8Oct 1, 2026Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcareUnitedHealthcare CommercialAllprior auth under conditionsonly with dx E66.01, E66.09, E66.1, E66.2, E66.3, E66.8Oct 1, 2026Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth under conditionsonly with dx E66.01, E66.09, E66.1, E66.2, E66.3, E66.8Sep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Individual Exchange plansAllprior auth under conditionsonly with dx E66.01, E66.09, E66.1, E66.2, E66.3, E66.8; not in AL, FL, GA, LA, OK, SC, TN, TX, VA, WA, WIOct 1, 2026Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare Mid-Atlantic Health PlansAllprior auth under conditionsonly with dx E66.01, E66.09, Z68.45Oct 1, 2026Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare West commercial plansAllprior auth under conditionsonly with dx E66.01, E66.09, E66.1, E66.2, E66.3, E66.8Oct 1, 2026Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare of the River ValleyAllprior auth under conditionsonly with dx E66.01, E66.09, E66.1, E66.2, E66.3, E66.8Oct 1, 2026Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026
UnitedHealthcare Community PlanAHCCCS Complete Care (ACC)AZprior auth requiredOct 1, 2026Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026
UnitedHealthcare Community PlanALTCS Developmentally DisabledAZprior auth requiredOct 1, 2026Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026
UnitedHealthcare Community PlanALTCS Long Term CareAZprior auth requiredOct 1, 2026Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026
UnitedHealthcare Community PlanKanCareKSprior auth requiredOct 1, 2026Prior authorization requirements for Kansas Medicaid Effective October 1, 2026
UnitedHealthcare Community PlanLouisiana Medicaid (Healthy Louisiana)LAprior auth requiredJan 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Louisiana
UnitedHealthcare Community PlanMaryland HealthChoiceMDprior auth requiredSep 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community PlanMichigan Medicaid, Healthy Michigan Plan, CSHCSMIprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Michigan, Healthy Michigan Plan and Children’s Special Health Care Services Effective October 1, 2026
UnitedHealthcare Community PlanMinnesota Metro MedicaidMNprior auth requiredOct 1, 2024Prior authorization requirements for Minnesota Medicaid Effective October 1, 2024
UnitedHealthcare Community PlanMississippi CHIPMSprior auth requiredApr 1, 2025Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community PlanMissouri MedicaidMOprior auth requiredJul 1, 2026Prior authorization requirements for Missouri Medicaid Effective July 1, 2026
UnitedHealthcare Community PlanNebraska Heritage HealthNEprior auth requiredJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Nebraska Effective July 1, 2026 General Information This list contains prior authorization requirements for participating United
UnitedHealthcare Community PlanNew Jersey FamilyCareNJprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U
UnitedHealthcare Community PlanNew Mexico Turquoise CareNMprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026
UnitedHealthcare Community PlanOhio MedicaidOHprior auth requiredNov 1, 2025Prior authorization requirements for Ohio Medicaid Effective November 1, 2025 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community Plan
UnitedHealthcare Community PlanPennsylvania CHIPPAprior auth requiredJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026
UnitedHealthcare Community PlanPennsylvania MedicaidPAprior auth requiredJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026
UnitedHealthcare Community PlanRhode Island MedicaidRIprior auth requiredMay 1, 2026Prior authorization requirements for Rhode Island Medicaid Effective May 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan of Rhode Island h
UnitedHealthcare Community PlanTennCareTNprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Tennessee Effective October 1, 2026
UnitedHealthcare Community PlanTexas CHIPTXprior auth requiredJan 1, 2015Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care
UnitedHealthcare Community PlanTexas STARTXprior auth requiredJan 1, 2015Prior authorization requirements for Texas STAR Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR h
UnitedHealthcare Community PlanTexas STAR KidsTXprior auth requiredNov 1, 2016Prior authorization requirements for STAR Kids Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR Ki
UnitedHealthcare Community PlanTexas STAR+PLUSTXprior auth requiredJan 1, 2015Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of FloridaFLprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of Hawaii (QUEST Integration)HIprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Hawaii Effective October 1, 2026
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of KentuckyKYprior auth under conditionsonly with dx E66.01, E66.09, E66.1, E66.2, E66.3, E66.8Jul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of New YorkNYprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026
UnitedHealthcare Community PlanVirginia Cardinal Care LTSSVAprior auth requiredOct 1, 2026Prior authorization requirements for Virginia Cardinal Care LTSS Effective October 1, 2026
UnitedHealthcare Community PlanVirginia Cardinal Care MedicaidVAprior auth requiredOct 1, 2026Prior authorization requirements for Virginia Cardinal Care Effective October 1, 2026
UnitedHealthcare Community PlanWashington Apple HealthWAprior auth requiredOct 1, 2026Prior authorization requirements for the UnitedHealthcare Community Plan of Washington Effective April 1, 2023
UnitedHealthcare Community PlanWisconsin BadgerCare Plus and Medicaid SSIWIprior auth requiredSep 1, 2026Prior authorization requirements for Wisconsin Medicaid Effective September 1, 2026 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community

Payer coverage policies that name 43860

43860 appears in 19 coverage policies from Aetna, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaAbdominoplasty, Suction Lipectomy, and Ventral Hernia Repair (0211)listed, no stance (range 43843-43888)Aug 18, 2026payer document
AetnaUpper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (0738)listed, no stance (range 43842-43888)Oct 29, 2025payer document
CenteneBariatric Surgery (CP.MP.37)covered if criteria are metSep 1, 2025payer document
CignaBariatric Surgery and Procedures (0051)covered if criteria are metJul 15, 2026payer document
CignaBariatric Surgery and Procedures (0051)not coveredJul 15, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Bariatric Surgery (SUR716.003)
CPT Codes 00797, 43281, 43290, 43291, 43332, 43333, 43334, 43335, 43336,		listed, no stanceJan 1, 2026payer document
RegenceBariatric Surgery (Surgery 58)listed, no stanceDec 1, 2025payer document
UnitedHealthcareBariatric Surgery (2026T0362RR)listed, no stanceMay 1, 2026payer document
UnitedHealthcareBariatric Surgery (CS007.X)listed, no stanceJul 1, 2026payer document
UnitedHealthcareBariatric Surgery (for Idaho Only) (CS007ID.D)listed, no stanceJul 1, 2026payer document
UnitedHealthcareBariatric Surgery (for Kansas Only) (CS007KS.02)listed, no stanceJul 1, 2026payer document
UnitedHealthcareBariatric Surgery (for Kentucky Only) (CS007KY.12)listed, no stanceAug 1, 2026payer document
UnitedHealthcareBariatric Surgery (for Nebraska Only) (CS007NE.V)listed, no stanceAug 1, 2026payer document
UnitedHealthcareBariatric Surgery (for New Jersey Only) (CS007NJ.Q)listed, no stanceJul 1, 2026payer document
UnitedHealthcareBariatric Surgery (for New Mexico Only) (CS007NM.C)listed, no stanceJul 1, 2026payer document
UnitedHealthcareBariatric Surgery (for North Carolina Only) (CSNCT0362.06)listed, no stanceJul 1, 2026payer document
UnitedHealthcareBariatric Surgery (for Ohio Only) (CS007OH.E)listed, no stanceJul 1, 2026payer document
UnitedHealthcareBariatric Surgery (for Pennsylvania Only) (CS007PA.S)listed, no stanceSep 1, 2026payer document
UnitedHealthcareBariatric Surgery (for Tennessee Only) (CS007TN.S)listed, no stanceJul 1, 2026payer document
UnitedHealthcareSurgical Procedures (MMP108.10)
Bariatric Surgery		listed, no stanceSep 1, 2026payer document

Recent prior-auth changes

  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Apr 1, 2026: conditions changed, UnitedHealthcare
  • Apr 1, 2026: PA removed, UnitedHealthcare Community Plan
  • Nov 1, 2025: conditions changed, UnitedHealthcare Community Plan
  • Oct 1, 2025: conditions changed, UnitedHealthcare
  • Oct 1, 2025: conditions changed, UnitedHealthcare
  • Jul 1, 2025: conditions changed, UnitedHealthcare
  • Mar 1, 2025: PA added, Rocky Mountain Health Plans
  • Mar 1, 2025: PA added, Rocky Mountain Health Plans
  • Dec 1, 2024: conditions changed, UnitedHealthcare

Medicaid fee-for-service

Prior authorization required or conditional in KY, ND.

  • AZ: $1671.18 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $1283.07 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $1179.10 (physician, non-facility), effective Jan 1, 2026
  • IL: $1154.50 (practitioner), effective Apr 1, 2024
  • IN: $1227.02 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $598.12 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $900.66 (physician, facility), effective Jan 1, 2026
  • LA: $267.04 (professional), effective Jul 1, 2025
  • MA: $1197.54 (physician_surgery), effective May 1, 2024
  • MS: $1263.07 (comprehensive), effective Jul 1, 2026
  • ND: $1550.41 (physician), effective Aug 1, 2026
  • NE: $1630.20 (physician, non-facility), effective Jul 1, 2026
  • NY: $741.00 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $897.95 (physician), effective Jan 1, 2024
  • OK: $1333.53 (physician, non-facility), effective Jul 1, 2026
  • TX: $187.53 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026
  • VA: $1313.37 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $872.94 (physician, facility), effective Jul 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

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.