61630 CPT® code: payer coverage and prior authorization5 of 5 payer prior-auth lists that name 61630 require prior authorization or set conditions: Cigna, Rocky Mountain Health Plans.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Oct 25, 2019 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Oct 25, 2019 | Master Precertification List (For Health Care Providers) |
| Cigna | Vascular Interventions | All | prior auth required | Experimental/investigational | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs |
| Cigna | Vascular Interventions | All | prior auth required | Experimental/investigational | Mar 7, 2026 | Cigna Vascular Interventions Commercial Code List (title from file name) |
| 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 |
61630 appears in 13 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Cerebrovascular Angioplasty, Stenting, and Select Surgical Procedures (0276) | covered if criteria are met | Sep 10, 2026 | payer document |
| Aetna | Grid Monitoring and Intraoperative Electroencephalography (0289) | listed, no stance (range 61623-61645) | Apr 17, 2026 | payer document |
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | covered if criteria are met (range 61623-61651) | Jun 19, 2026 | payer document |
| Aetna | Intravascular Ultrasound (0382) | listed, no stance | May 26, 2026 | payer document |
| Aetna | Intravenous Iron Therapy (0575) | listed, no stance (range 61000-64999) | Jul 1, 2026 | payer document |
| Aetna | Respiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479) | listed, no stance (range 61000-64999) | Jul 9, 2026 | payer document |
| Aetna | Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (0703) | listed, no stance (range 61000-64999) | Nov 24, 2025 | payer document |
| Anthem | Carotid, Vertebral and Intracranial Artery Stent Placement with or without Angioplasty (CG-SURG-76) | not covered | Aug 13, 2026 | payer document |
| Anthem | Venous Angioplasty with or without Stent Placement or Venous Stenting Alone (CG-SURG-106) | covered if criteria are met | Feb 19, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Endovascular Procedures For Intracranial Arterial Disease Atherosclerosis And Aneurysms | covered if criteria are met | payer document | |
| Blue Cross Blue Shield of Massachusetts | Endovascular Procedures for Intracranial Arterial Disease (323) | listed, no stance | payer document | |
| Blue Cross NC | Endovascular Procedures for Intracranial Arterial Disease | listed, no stance | May 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms) (SUR701.027) CPT Codes 36221, 36222, 36223, 36224, 36225, 36226, 36227, 36228, 61624, | listed, no stance | Dec 1, 2025 | payer document |
Prior authorization required or conditional in IN.
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.