61797 CPT® code: payer coverage and prior authorization6 of 8 payer prior-auth lists that name 61797 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Cigna, Humana.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Feb 17, 2014 | Master Precertification List (For Health Care Providers) |
| Cigna | Basic Standard | All | prior auth required | May be delegated to eviCore for some clients | Feb 17, 2014 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Feb 17, 2014 | Master Precertification List (For Health Care Providers) |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community Health Plans (BCCHP), Illinois Medicaid | IL | prior auth required | Carelon-managed | Aug 1, 2025 | Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026 |
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jul 1, 2026 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
| Humana | Humana Healthy Horizons | KY | prior auth required | Jan 1, 2027 | please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. |
61797 appears in 27 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, BlueCross BlueShield of South Carolina, Centene, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Epilepsy Surgery (0394) | covered if criteria are met | Jun 23, 2026 | payer document |
| Aetna | Headaches: Invasive Procedures (0707) | not covered | Jul 23, 2026 | payer document |
| Aetna | Inpatient Admission Prior to Surgery (Preop Days) (0255) | listed, no stance | May 13, 2026 | payer document |
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | covered if criteria are met (range 61796-61800) | Jun 19, 2026 | payer document |
| Aetna | Intravenous Iron Therapy (0575) | listed, no stance (range 61000-64999) | Jul 1, 2026 | payer document |
| Aetna | Proton Beam, Neutron Beam, and Carbon Ion Radiotherapy (0270) | covered if criteria are met | Apr 14, 2026 | payer document |
| Aetna | Proton Beam, Neutron Beam, and Carbon Ion Radiotherapy (0270) | listed, no stance | Apr 14, 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 | Stereotactic Radiosurgery (0083) | covered if criteria are met | Mar 11, 2026 | payer document |
| Aetna | Thalamotomy (0153) | covered if criteria are met | Mar 30, 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 |
| Aetna | Trigeminal Neuralgia: Treatments (0374) | covered if criteria are met | Jun 29, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Stereotactic Radiosurgery And Stereotactic Body Radiotherapy | covered if criteria are met | payer document | |
| Blue Cross NC | Radiosurgery, Stereotactic Approach | listed, no stance | May 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy (CAM 60110) | listed, no stance (range 61796-61799) | Sep 1, 2025 | payer document |
| Centene | Stereotactic Body Radiation Therapy (CP.MP.22) | covered if criteria are met | Oct 1, 2025 | payer document |
| Regence | Charged-Particle (Proton) Radiotherapy (Medicine 49) | listed, no stance | Aug 1, 2025 | payer document |
| Regence | Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy for Tumors Outside of Intracranial, Skull Base, or Orbital Sites (Surgery 214) | listed, no stance | Sep 1, 2025 | payer document |
| Regence | Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy of Intracranial, Skull Base, and Orbital Sites (Surgery 213) | listed, no stance | Sep 1, 2025 | payer document |
| UnitedHealthcare | Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (CS180.J) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (2026T0611K) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (for Idaho Only) (CS180ID.C) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (for Kansas Only) (CS180KS.02) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (for Kentucky Only) (CS180KY.05) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (for New Jersey Only) (CS180NJ.F) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (for New Mexico Only) (CS180NM.D) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (for North Carolina Only) (CSNCT0611.05) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Stereotactic Body Radiation Therapy and Stereotactic Radiosurgery (for Ohio Only) (CS180OH.E) | listed, no stance | Feb 1, 2026 | payer document |
Prior authorization required or conditional in VA, WA, WV.
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.