67221 CPT® code: payer coverage and prior authorization2 of 2 payer prior-auth lists that name 67221 require prior authorization or set conditions: Neighborhood Health Partnership, UnitedHealthcare.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | site of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WI | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth under conditions | site of care: outpatient hospital | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 |
67221 appears in 8 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, BlueCross BlueShield of South Carolina, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Age-Related Macular Degeneration (0765) | covered if criteria are met | Jan 14, 2026 | payer document |
| Aetna | Verteporfin (Visudyne) Photodynamic Therapy (0594) | covered if criteria are met | Apr 24, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Photodynamic Therapy For Choroidal Neovascularization | covered if criteria are met | payer document | |
| Blue Cross Blue Shield of Massachusetts | Photodynamic Therapy for Choroidal Neovascularization (599) | listed, no stance | payer document | |
| Blue Shield of California | Photodynamic Therapy for Choroidal Neovascularization (9.03.08) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Photodynamic Therapy for Choroidal Neovascularization (CAM 90308) | listed, no stance | Dec 1, 2025 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Photodynamic Therapy for Choroidal Neovascularization (OTH903.015) | listed, no stance | Oct 15, 2026 | payer document |
| Regence | Surgical Site of Care – Hospital Outpatient (Utilization Management 19) | listed, no stance | May 1, 2026 | 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.