Payer policies › CPT 6970569705 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 69705 16 of 16 payer prior-auth lists that name 69705 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, CarePlus Health Plans, Cigna, Humana, Rocky Mountain Health Plans.
Payer Plan State Prior auth Conditions Since Source Cigna ACA/IFP All prior auth required May be delegated to eviCore for some clients Jan 1, 2021 Master Precertification List (For Health Care Providers) Cigna Complete/PHS+/Preferred All prior auth required May be delegated to eviCore for some clients Jan 1, 2021 Master Precertification List (For Health Care Providers) Cigna Other Services All prior auth required Mar 7, 2026 Cigna Commercial Prior Authorization Procedure Code List: Other Services Cigna Other Services All prior auth required Mar 7, 2026 Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs Blue Cross and Blue Shield of Texas Texas PA exemption (gold card), outpatient, fully insured TX prior auth required Gold-card exemption available Jul 1, 2026 BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Humana Oak Street Health All prior auth under conditions Excludes diagnostic nasal/sinus endoscopies Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management Rocky Mountain Health Plans Rocky Mountain Medicare Advantage D-SNP CO prior auth required Feb 1, 2025 Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
Payer coverage policies that name 69705 69705 appears in 11 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, BlueCross BlueShield of South Carolina, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Aetna Intraoperative Neurophysiological Monitoring (0697) covered if criteria are met Jun 19, 2026 payer document Aetna Myringotomy and Tympanostomy Tube (0418) covered if criteria are met Jun 30, 2026 payer document Aetna Myringotomy and Tympanostomy Tube (0418) listed, no stance (range 69420-69799) Jun 30, 2026 payer document Anthem Balloon Dilation of the Eustachian Tubes (CG-SURG-117) covered if criteria are met Aug 13, 2026 payer document Blue Cross & Blue Shield of Mississippi Balloon Dilation Of The Eustachian Tube (A.7.01.158) listed, no stance payer document Blue Cross & Blue Shield of Rhode Island Balloon Dilation of the Eustachian Tube covered if criteria are met May 20, 2026 payer document Blue Cross Blue Shield of Massachusetts Balloon Dilation of the Eustachian Tube (018) listed, no stance payer document Blue Cross NC Balloon Dilation of the Eustachian Tube listed, no stance Feb 1, 2026 payer document BlueCross BlueShield of South Carolina Balloon Dilation of the Eustachian Tube (CAM 701158) listed, no stance Dec 1, 2025 payer document Cigna Balloon Sinus Ostial Dilation for Chronic Sinusitis and Eustachian Tube Dilation (0480) covered if criteria are met Apr 15, 2026 payer document Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) Balloon Dilation of the Eustachian Tube (SUR706.018) listed, no stance Oct 15, 2026 payer document Premera Blue Cross Balloon Dilation of the Eustachian Tube (7.01.606) listed, no stance Apr 14, 2026 payer document
Recent prior-auth changes Oct 1, 2026: PA removed, Oxford Health Plans Jan 1, 2026: PA removed, Humana Mar 1, 2025: PA removed, Rocky Mountain Health Plans Mar 1, 2025: PA removed, Rocky Mountain Health Plans Medicaid fee-for-service AZ: $2580.41 (asc), effective Oct 1, 2026 IL: $119.17 (practitioner), effective Apr 1, 2024 IN: $133.48 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $2165.61 (asc, facility), effective Jan 1, 2021 KY: $4089.81 (asc), effective Jan 1, 2026 LA: $2028.86 (professional), effective Jan 1, 2021 MA: $3033.36 (asc), effective May 1, 2026 MS: $3389.63 (comprehensive, facility), effective Oct 1, 2025 ND: $2410.95 (physician, facility), effective Aug 1, 2026 NE: $160.05 (physician, non-facility), effective Jul 1, 2026 NY: $92.67 (physician_surgery, facility), effective Jul 1, 2026 OH: $135.54 (physician, facility), effective Jan 1, 2024 TX: $2916.73 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VT: $4596.52 (outpatient_hospital_opps), effective Feb 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.