55876 CPT® code: payer coverage and prior authorization5 of 7 payer prior-auth lists that name 55876 require prior authorization or set conditions: Cigna, HealthSpring, Humana.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Aug 1, 2012 | Master Precertification List (For Health Care Providers) |
| Cigna | Basic Standard | All | prior auth required | May be delegated to eviCore for some clients | Aug 1, 2012 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Aug 1, 2012 | Master Precertification List (For Health Care Providers) |
| HealthSpring | Medicare Advantage | All | prior auth required | Jan 1, 2025 | 2026 Q4 Prior Authorization List | |
| Humana | Humana Puerto Rico MA and Dual Medicare-Medicaid | PR | prior auth required | Nov 3, 2025 | Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification |
55876 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Brachytherapy (0371) | covered if criteria are met | May 20, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Brachytherapy For Clinically Localized Prostate Cancer Using Permanently Implanted Seeds (L.8.01.417) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Highdose Rate Temporary Prostate Brachytherapy | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Realtime Intrafraction Motion Management During Radiation Therapy (L.2.03.401) | unproven / investigational | 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.