64804 CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 64804 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| 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) |
64804 appears in 8 coverage policies from Aetna, Blue Shield of California.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Headaches: Invasive Procedures (0707) There is no specific code for Ganglionectomy | not covered | Jul 23, 2026 | payer document |
| Aetna | Hyperhidrosis (0504) | covered if criteria are met (range 64802-64823) | Aug 11, 2026 | payer document |
| Aetna | Intravenous Iron Therapy (0575) | listed, no stance (range 61000-64999) | Jul 1, 2026 | payer document |
| Aetna | Post-Herpetic Neuralgia (0725) | not covered (range 64802-64818) | Oct 20, 2025 | 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 |
| Aetna | Thoracoscopic Sympathectomy (0310) | listed, no stance | May 20, 2026 | payer document |
| Blue Shield of California | | Treatment of Hyperhidrosis (8.01.19) | listed, no stance | 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.