55899 CPT® code: payer coverage and prior authorization49 of 49 payer prior-auth lists that name 55899 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Cigna, HealthSpring, Humana, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of South Carolina, Molina Healthcare of Texas, Molina Healthcare of Utah, and others.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | Federal Employee Program (FEP) | AZ | prior auth under conditions | Only gender dysphoria dx, members in treatment as of 1/1/26 | Sep 1, 2026 | Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 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 |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community Health Plans (BCCHP), Illinois Medicaid | IL | prior auth required | Jan 1, 2023 | Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026 | |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative) | IL | prior auth required | Jan 1, 2023 | Procedure Code List, Effective 1/1/2025 | |
| HealthSpring | Medicare Advantage | All | prior auth required | Apr 1, 2025 | 2026 Q4 Prior Authorization List | |
| Humana | Humana Healthy Horizons | KY | prior auth required | Jan 1, 2027 | please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. | |
| Humana | Humana Healthy Horizons | LA | prior auth required | Jan 1, 2027 | Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate | |
| Humana | Humana Healthy Horizons | OH | prior auth required | Jan 1, 2027 | 555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification 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 | |
| Humana | Oak Street Health | All | prior auth required | Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management | ||
| Molina Complete Care (Virginia) | Medicare-only PA matrix for D-SNP | VA | prior auth required | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022 | |
| Molina Complete Care (Virginia) | Medicaid | VA | prior auth required | Apr 1, 2025 | Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 | |
| Molina Healthcare of Arizona | Medicare-only PA matrix for D-SNP | AZ | prior auth required | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022 | |
| Molina Healthcare of California | Medicare Advantage | CA | prior auth required | Jul 1, 2021 | Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021 | |
| Molina Healthcare of California | Medicaid | CA | prior auth required | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 | |
| Molina Healthcare of Florida | Medicare Advantage | FL | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021 | |
| Molina Healthcare of Idaho | Medicare Advantage | ID | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021 | |
| Molina Healthcare of Idaho | Medicaid | ID | prior auth required | Jan 1, 2025 | Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025 | |
| Molina Healthcare of Illinois | Medicaid | IL | prior auth required | Jan 1, 2022 | Molina Healthcare of Illinois Codification Grid Q3 2026 | |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Molina Healthcare of Michigan | Medicaid | MI | prior auth required | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 | |
| Molina Healthcare of Michigan | Exchange | MI | prior auth required | Jul 1, 2021 | Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 | |
| Molina Healthcare of Michigan | Medicare Advantage | MI | prior auth required | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 | |
| Molina Healthcare of Mississippi | Medicaid | MS | prior auth required | Jan 1, 2025 | Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 | |
| Molina Healthcare of Nevada | Medicaid | NV | prior auth required | Oct 1, 2022 | Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 | |
| Molina Healthcare of New Mexico | Medicare Advantage | NM | prior auth required | Jan 1, 2021 | Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021 | |
| Molina Healthcare of New Mexico | Medicaid | NM | prior auth required | Jul 1, 2026 | New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026 | |
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Medicare and MyCare Ohio (MMP) Medicare | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Exchange | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of South Carolina | Medicare Advantage | SC | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021 | |
| Molina Healthcare of Texas | STAR | TX | prior auth required | Feb 19, 2025 | Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19 | |
| Molina Healthcare of Texas | STAR+PLUS | TX | prior auth required | Feb 19, 2025 | Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19 | |
| Molina Healthcare of Texas | STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix) | TX | prior auth required | Jul 1, 2026 | Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 | |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Sep 1, 2019 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 | |
| Molina Healthcare of Utah | Medicare Advantage | UT | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021 | |
| Molina Healthcare of Washington | Medicare Advantage | WA | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021 | |
| Molina Healthcare of Wisconsin | Medicare Advantage | WI | prior auth required | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021 | |
| Molina Healthcare, Inc. (national grid) | Molina national (MHI) Medicare grid | All | prior auth required | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021 | |
| Passport by Molina Healthcare (Kentucky) | Medicaid | KY | prior auth required | Jul 1, 2026 | Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026 | |
| Oxford Health Plans | Oxford Health Plans | All | prior auth required | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 | |
| Rocky Mountain Health Plans | Rocky Mountain Medicare Advantage D-SNP | CO | prior auth under conditions | only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890 | Feb 1, 2025 | Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth required | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | Maryland HealthChoice | MD | prior auth under conditions | only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890 | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026 |
55899 appears in 40 coverage policies from Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Blue Shield of California, Centene, Cigna, Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Anthem | Assisted Reproductive Technology (CG-MED-103) | not covered | Nov 6, 2025 | payer document |
| Anthem | Autologous Adipose-derived Regenerative Cell Therapy (MED.00132) | unproven / investigational | Nov 6, 2025 | payer document |
| Anthem | Cosmetic and Reconstructive Services of the Trunk, Groin, and Extremities (ANC.00009) | not covered | Aug 13, 2026 | payer document |
| Anthem | Histotripsy (SURG.00165) | unproven / investigational | Aug 13, 2026 | payer document |
| Anthem | MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic Indications (MED.00057) | unproven / investigational | Aug 13, 2026 | payer document |
| Anthem | Nanoparticle-Mediated Thermal Ablation (SURG.00161) For the following unlisted codes when specified as nanoparticle thermal ablation | unproven / investigational | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Focal Treatments For Prostate Cancer | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Magnetic Resonance Imagingtargeted Biopsy Of The Prostate (L.7.01.448) | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Mississippi | Realtime Intrafraction Motion Management During Radiation Therapy (L.2.03.401) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Transurethral Water Vapor Thermal Therapy And Transurethral Water Jet Ablation Aquablation For Benign Prostatic Hyperplasia | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Focal Treatments for Prostate Cancer | not covered | Jun 17, 2026 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Gender Affirming Care Medicare Advantage Plans and Commercial Products | listed, no stance | Apr 1, 2026 | payer document |
| Blue Cross NC | Focal Treatments for Prostate Cancer | listed, no stance | Nov 1, 2025 | payer document |
| Blue Shield of California | Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hyperplasia (2.01.49) | listed, no stance | payer document | |
| Blue Shield of California | | Focal Treatments for Prostate Cancer (8.01.61) | listed, no stance | payer document | |
| Centene | Fertility Preservation (CP.MP.130) | covered if criteria are met | Jan 1, 2026 | payer document |
| Centene | Fertility Preservation (CP.MP.130) | not covered | Jan 1, 2026 | payer document |
| Cigna | Benign Prostatic Hyperplasia (BPH) Surgical Treatments (0159) | not covered | Sep 15, 2026 | payer document |
| Cigna | Gender Dysphoria Treatment (0266) | covered if criteria are met | Sep 15, 2026 | payer document |
| Cigna | Infertility Services (0089) | covered if criteria are met | Jun 15, 2025 | payer document |
| Cigna | Infertility Services (0089) | unproven / investigational | Jun 15, 2025 | payer document |
| Cigna | Vascularized Composite Allograft (VCA) Transplantation (0560) | unproven / investigational | Jan 15, 2026 | payer document |
| Premera Blue Cross | Focal Treatments for Prostate Cancer (8.01.541) Page | 2 of 18 | ∞ | listed, no stance | Apr 13, 2026 | payer document |
| Premera Blue Cross | Magnetic Resonance Imaging–Guided Focused Ultrasound (7.01.109) | listed, no stance | Sep 7, 2026 | payer document |
| Regence | Cryosurgical Ablation of Miscellaneous Solid Tumors Outside of the Liver (Surgery 132) | listed, no stance | Jan 1, 2026 | payer document |
| Regence | Extracorporeal Shock Wave Therapy (ESWT) (Medicine 90) | listed, no stance | Nov 1, 2025 | payer document |
| Regence | Gender Affirming Interventions for Gender Dysphoria (Medicine 153) NOTES | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Prostate Services and Procedures and Impotence Treatment (MMP075.14) Nerve Graft to Restore Erectile Function During Radical Prostatectomy | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (2026T0618P) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (CS334.H) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Idaho Only) (CS334ID.C) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Indiana Only) (CS334IN.09) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Kansas Only) (CS334KS.02) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Kentucky Only) (CS334KY.12) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Nebraska Only) (CS334NE.I) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for New Jersey Only) (CS334NJ.G) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for New Mexico Only) (CS334NM.D) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for North Carolina Only) (CSNCT0705.09) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Ohio Only) (CS334OH.E) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Pennsylvania Only) (CS334PA.H) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Prostate Surgeries and Interventions (for Tennessee Only) (CS334TN.H) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Urinary and Fecal Incontinence: Diagnosis and Treatment (MMP049.14) when used to report UroCuff | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in FL, IN, KY, VT, WA, WV, WY.
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.