69604 CPT® code: payer coverage and prior authorization2 of 2 payer prior-auth lists that name 69604 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross and Blue Shield of Illinois | Blue Cross Community Health Plans (BCCHP), Illinois Medicaid | IL | prior auth required | Oct 1, 2026 | Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026 | |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative) | IL | prior auth required | Jan 1, 2025 | Procedure Code List, Effective 1/1/2025 |
69604 appears in 3 coverage policies from Aetna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Grid Monitoring and Intraoperative Electroencephalography (0289) | listed, no stance (range 69601-69605) | Apr 17, 2026 | payer document |
| Aetna | Myringotomy and Tympanostomy Tube (0418) | listed, no stance (range 69420-69799) | Jun 30, 2026 | payer document |
| Aetna | Tinnitus Treatments (0406) | listed, no stance (range 69601-69604) | Jul 10, 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.