66989 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 66989

10 of 10 payer prior-auth lists that name 66989 require prior authorization or set conditions: CarePlus Health Plans, Humana, Rocky Mountain Health Plans.

PayerPlanStatePrior authConditionsSinceSource
CarePlus Health PlansCarePlus Health PlansFLprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaHumana D-SNP (FL)FLprior auth requiredJan 1, 20271 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
HumanaHumana D-SNP (IL)ILprior auth requiredJan 1, 2027Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
HumanaHumana D-SNP (IN)INprior auth requiredJan 1, 2027*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
HumanaHumana D-SNP (MI)MIprior auth requiredJan 1, 20271 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
HumanaHumana D-SNP (SC)SCprior auth requiredJan 1, 2027Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
HumanaHumana D-SNP (VA)VAprior auth requiredJan 1, 2027Virginia Prior Authorization and Notification List
HumanaHumana MA and D-SNPAllprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Rocky Mountain Health PlansRocky Mountain Medicare Advantage D-SNPCOprior auth requiredFeb 1, 2025Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025

Payer coverage policies that name 66989

66989 appears in 21 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Capital Blue Cross, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaGlaucoma Surgery (0484)covered if criteria are metJul 14, 2026payer document
AetnaGlaucoma Surgery (0484)listed, no stanceJul 14, 2026payer document
AetnaIntracameral Implants (1065)listed, no stance (range 66820-66991)Jun 30, 2026payer document
AetnaVitrectomy (0393)not coveredJul 8, 2026payer document
AnthemIntraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir) (CG-SURG-118)covered if criteria are metFeb 19, 2026payer document
Blue Cross & Blue Shield of MississippiAqueous Shunts And Stents For Glaucomacovered if criteria are metpayer document
Blue Cross & Blue Shield of Rhode IslandAqueous Shunts and Stents for Glaucoma sad
Medicare Advantage Plans and Commercial Products		listed, no stanceMar 1, 2024payer document
Blue Cross Blue Shield of MassachusettsAqueous Shunts and Stents for Glaucoma (223)listed, no stancepayer document
Blue Cross NCAqueous Shunts and Devices for Glaucomalisted, no stanceJun 1, 2026payer document
Capital Blue CrossAqueous Shunts and Stents for Glaucoma (MP 2.149)
Procedure codes		covered if criteria are metApr 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (2026T0443MM)listed, no stanceSep 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (CS050.Y)listed, no stanceSep 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (for Idaho Only) (CS050ID.C)listed, no stanceJun 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (for Kansas Only) (CS050KS.03)listed, no stanceFeb 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (for Kentucky Only) (CS050KY.09)listed, no stanceMar 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (for Nebraska Only) (CS050NE.Y)listed, no stanceSep 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (for New Jersey Only) (CS050NJ.V)listed, no stanceSep 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (for New Mexico Only) (CS050NM.E)listed, no stanceSep 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (for North Carolina Only) (CSNCT0443.04)listed, no stanceMay 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (for Ohio Only) (CS050OH.D)listed, no stanceApr 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (for Pennsylvania Only) (CS050PA.V)listed, no stanceSep 1, 2026payer document
UnitedHealthcareGlaucoma Surgical Treatments (for Tennessee Only) (CS050TN.V)listed, no stanceFeb 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, Oxford Health Plans
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans

Medicaid fee-for-service

Prior authorization required or conditional in WA.

  • AZ: $3236.64 (asc), effective Oct 1, 2026
  • CO: $698.94 (health_first_colorado), effective Jul 1, 2026
  • IL: $565.01 (practitioner), effective Apr 1, 2024
  • IN: $657.58 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $1925.18 (asc, facility), effective Jan 1, 2022
  • KY: $3879.11 (asc), effective Jan 1, 2026
  • LA: $733.14 (professional), effective Jan 1, 2022
  • MA: $2757.89 (asc), effective May 1, 2026
  • MS: $3010.30 (comprehensive, facility), effective Oct 1, 2025
  • MT: $715.07 (optometric, facility), effective Jul 1, 2025
  • ND: $2286.74 (physician, facility), effective Aug 1, 2026
  • NE: $702.46 (physician, non-facility), effective Jul 1, 2026
  • NY: $470.21 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $640.26 (physician), effective Jan 1, 2022
  • OK: $637.24 (physician, non-facility), effective Jul 1, 2026
  • TX: $2595.66 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $622.69 (medical, facility), effective Jul 1, 2026
  • VT: $4131.79 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $415.35 (asc), effective Jul 1, 2026
  • WY: $2353.28 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

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.