Payer policies › CPT 6963569635 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 69635 2 of 2 payer prior-auth lists that name 69635 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
Payer coverage policies that name 69635 69635 appears in 4 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Blood and Adipose Tissue Derived Products for Selected Indications (0784) listed, no stance Nov 19, 2025 payer document Aetna Grid Monitoring and Intraoperative Electroencephalography (0289) listed, no stance (range 69635-69646) 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 69631-69646) Jul 10, 2026 payer document
Recent prior-auth changes Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, Oxford Health Plans Oct 1, 2026: PA removed, UnitedHealthcare Community Plan Aug 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, Neighborhood Health Partnership Jul 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, UnitedHealthcare Medicaid fee-for-service Prior authorization required or conditional in WV.
AZ: $1943.46 (asc), effective Oct 1, 2026 CO: $1048.47 (chp_plus, non-facility), effective Jul 1, 2026 FL: $914.65 (physician, non-facility), effective Jan 1, 2026 IL: $859.85 (practitioner), effective Apr 1, 2024 IN: $975.21 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $478.82 (asc, facility), effective Jan 1, 2000 KY: $2953.46 (asc), effective Jan 1, 2026 LA: $265.13 (asc), effective Jul 1, 2012 MA: $1909.57 (asc), effective May 1, 2026 MS: $2333.88 (comprehensive, facility), effective Oct 1, 2025 ND: $1741.07 (physician, facility), effective Aug 1, 2026 NE: $1233.00 (asc), effective Jul 1, 2024 NY: $606.00 (physician_surgery, facility), effective Jul 1, 2026 OH: $788.21 (physician), effective Jan 1, 2024 OK: $2694.50 (asc), effective Jan 1, 2026 TX: $1954.22 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $1018.81 (medical), effective Jul 1, 2026 VT: $4596.52 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $366.60 (asc), effective Jul 1, 2026 WY: $2617.97 (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.