68899 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 68899

38 of 38 payer prior-auth lists that name 68899 require prior authorization or set conditions: Cigna, Humana, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of South Carolina, Molina Healthcare of Texas, Molina Healthcare of Utah, Molina Healthcare of Washington, Molina Healthcare of Wisconsin, Molina Healthcare, Inc. (national grid), and others.

PayerPlanStatePrior authConditionsSinceSource
CignaACA/IFPAllprior auth requiredMay be delegated to eviCore for some clientsOct 1, 2006Master Precertification List (For Health Care Providers)
CignaBasic StandardAllprior auth requiredMay be delegated to eviCore for some clientsOct 1, 2006Master Precertification List (For Health Care Providers)
CignaComplete/PHS+/PreferredAllprior auth requiredMay be delegated to eviCore for some clientsOct 1, 2006Master Precertification List (For Health Care Providers)
CignaOther ServicesAllprior auth requiredMar 7, 2026Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
CignaOther ServicesAllprior auth requiredMar 7, 2026Cigna Commercial Prior Authorization Procedure Code List: Other Services
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Molina Complete Care (Virginia)Medicare-only PA matrix for D-SNPVAprior auth requiredJan 1, 2022Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022
Molina Complete Care (Virginia)MedicaidVAprior auth requiredApr 1, 2025Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
Molina Healthcare of ArizonaMedicare-only PA matrix for D-SNPAZprior auth requiredJan 1, 2022Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022
Molina Healthcare of CaliforniaMedicare AdvantageCAprior auth requiredJul 1, 2021Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021
Molina Healthcare of CaliforniaMedicaidCAprior auth requiredApr 1, 2026Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of FloridaMedicare AdvantageFLprior auth requiredApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021
Molina Healthcare of IdahoMedicaidIDprior auth requiredJan 1, 2025Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
Molina Healthcare of IdahoMedicare AdvantageIDprior auth requiredApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021
Molina Healthcare of IllinoisMedicaidILprior auth requiredJan 1, 2022Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of IowaMedicaidIAprior auth requiredJul 1, 2023IA Prior Authorization Matrix, effective Q3 2023
Molina Healthcare of MichiganMedicaidMIprior auth requiredJul 1, 2026Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of MichiganExchangeMIprior auth requiredJul 1, 2021Molina Healthcare of Michigan PA Matrix, effective 7/1/2021
Molina Healthcare of MississippiMedicaidMSprior auth requiredJan 1, 2025Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
Molina Healthcare of NevadaMedicaidNVprior auth requiredOct 1, 2022Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022
Molina Healthcare of New MexicoMedicare AdvantageNMprior auth requiredJan 1, 2021Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021
Molina Healthcare of New MexicoMedicaidNMprior auth requiredJul 1, 2026New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026
Molina Healthcare of OhioMedicaid and MyCare Ohio (MMP) MedicaidOHprior auth requiredOct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of OhioMedicare and MyCare Ohio (MMP) MedicareOHprior auth requiredOct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of OhioExchangeOHprior auth requiredOct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of South CarolinaMedicare AdvantageSCprior auth requiredApr 1, 2021Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021
Molina Healthcare of TexasSTARTXprior auth requiredFeb 19, 2025Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19
Molina Healthcare of TexasSTAR+PLUSTXprior auth requiredFeb 19, 2025Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19
Molina Healthcare of TexasSTAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix)TXprior auth requiredJul 1, 2026Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3
Molina Healthcare of TexasExchangeTXprior auth requiredSep 1, 2019Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026
Molina Healthcare of UtahMedicare AdvantageUTprior auth requiredApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021
Molina Healthcare of UtahMedicaidUTprior auth requiredJan 1, 2025Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
Molina Healthcare of WashingtonMedicare AdvantageWAprior auth requiredApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021
Molina Healthcare of WisconsinMedicare AdvantageWIprior auth requiredOct 1, 2021Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021
Molina Healthcare, Inc. (national grid)Molina national (MHI) Medicare gridAllprior auth requiredOct 1, 2021Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021
Passport by Molina Healthcare (Kentucky)MedicaidKYprior auth requiredJul 1, 2026Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
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
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth requiredSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026

Recent prior-auth changes

  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Jul 24, 2026: PA removed, Humana
  • Jul 1, 2026: PA removed, Humana
  • Jan 1, 2026: PA removed, Molina Healthcare of Michigan
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans

Medicaid fee-for-service

Prior authorization required or conditional in FL, KY, VT, WV, WY.

  • AZ: $189.43 (outpatient_hospital), effective Oct 1, 2021
  • FL: $377.32 (physician, non-facility), effective Jan 1, 2026
  • IN: $0.00 (professional, facility), effective Oct 15, 2020
  • KY: $45.00 (asc), effective Jan 1, 2026
  • MS: $241.04 (comprehensive), effective Jul 1, 2026
  • MT: $0.00 (optometric, facility), effective Jul 1, 2025
  • ND: $0.00 (physician), effective Aug 1, 2026
  • OK: $0.00 (physician, non-facility), effective Jul 1, 2026
  • TX: $0.00 (physician, Physician, facility), effective Dec 19, 1976
  • VT: $246.45 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $140.37 (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.