69717 CPT® code: payer coverage and prior authorization29 of 30 payer prior-auth lists that name 69717 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, HealthSpring, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Iowa, Molina Healthcare of Michigan, 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.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | State of Arizona employee group (SYD, S3Z) | AZ | prior auth required | Sep 1, 2026 | State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) | |
| 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 | |
| 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) |
| HealthSpring | Medicare Advantage | All | prior auth required | Jan 1, 2025 | 2026 Q4 Prior Authorization List | |
| Molina Complete Care (Virginia) | Medicare-only PA matrix for D-SNP | VA | prior auth required | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022 | |
| Molina Healthcare of Arizona | Medicare-only PA matrix for D-SNP | AZ | prior auth required | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022 | |
| Molina Healthcare of California | Medicare Advantage | CA | prior auth required | Jul 1, 2021 | Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021 | |
| Molina Healthcare of Florida | Medicare Advantage | FL | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021 | |
| Molina Healthcare of Idaho | Medicare Advantage | ID | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021 | |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Molina Healthcare of Michigan | Exchange | MI | prior auth required | Jul 1, 2021 | Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 | |
| Molina Healthcare of Nevada | Medicaid | NV | prior auth required | Oct 1, 2022 | Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 | |
| Molina Healthcare of New Mexico | Medicare Advantage | NM | prior auth required | Jan 1, 2021 | Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021 | |
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Medicare and MyCare Ohio (MMP) Medicare | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Exchange | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of South Carolina | Medicare Advantage | SC | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021 | |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Sep 1, 2019 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 | |
| Molina Healthcare of Utah | Medicare Advantage | UT | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021 | |
| Molina Healthcare of Washington | Medicare Advantage | WA | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021 | |
| Molina Healthcare of Wisconsin | Medicare Advantage | WI | prior auth required | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021 | |
| Molina Healthcare, Inc. (national grid) | Molina national (MHI) Medicare grid | All | prior auth required | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021 | |
| Rocky Mountain Health Plans | Rocky Mountain Health Plans CHP+ | CO | prior auth required | Oct 1, 2026 | Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026 | |
| 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 | |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth required | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 | |
| UnitedHealthcare Community Plan | Massachusetts Senior Care Options (SCO) and OneCare | MA | prior auth required | Oct 1, 2026 | Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | North Carolina Medicaid | NC | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of North Carolina Effective October 1, 2026 July 1, 2024 | |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Kentucky | KY | prior auth under conditions | Cost over $500 | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026 |
69717 appears in 24 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Blue Shield of California, Centene, Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Bone-Anchored Hearing Aids (0403) | covered if criteria are met | Jul 22, 2026 | payer document |
| Aetna | Cochlear Implants and Auditory Brainstem Implants (0013) | listed, no stance | Aug 18, 2026 | payer document |
| Aetna | Myringotomy and Tympanostomy Tube (0418) | listed, no stance (range 69420-69799) | Jun 30, 2026 | payer document |
| Anthem | Bone-Anchored and Bone Conduction Hearing Aids (CG-SURG-82) | covered if criteria are met | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Implantable Boneconduction And Boneanchored Hearing Aids | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Implantable Bone- Conduction and Bone-Anchored Hearing Aids | covered if criteria are met | Apr 16, 2025 | payer document |
| Blue Cross NC | Implantable Bone Conduction Hearing Aids | listed, no stance | Feb 1, 2026 | payer document |
| Blue Shield of California | Implantable Bone-Conduction and Bone-Anchored Hearing Aids (7.01.03) | listed, no stance | payer document | |
| Centene | Bone-Anchored Hearing Aid (CP.MP.93) | covered if criteria are met | May 1, 2026 | payer document |
| Premera Blue Cross | Implantable Bone-Conduction and Bone-Anchored Hearing Aids (7.01.547) Page | 5 of 26 | ∞ | listed, no stance | Apr 13, 2026 | payer document |
| Regence | Transcutaneous Bone-Conduction and Bone-Anchored Hearing Aids (Surgery 121) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone- Anchored, and Semi-Implantable (for Kansas Only) (CS052KS.04) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone- Anchored, and Semi-Implantable (for Nebraska Only) (CS052NE.V) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone- Anchored, and Semi-Implantable (for New Jersey Only) (CS052NJ.S) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone- Anchored, and Semi-Implantable (for Tennessee Only) (CS052TN.T) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (2026T0396II) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (CS052.V) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for Idaho Only) (CS052ID.D) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for Louisiana Only) (CS052LA.O) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Aug 1, 2025 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for New Mexico Only) (CS052NM.D) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for North Carolina Only) (CSNCT0396.10) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for Ohio Only) (CS052OH.F) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Hearing Aids and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for Pennsylvania Only) (CS052PA.S) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Hearing Instruments and Devices Including Wearable, Bone-Anchored, and Semi-Implantable (for Kentucky Only) (CS052KY.13) Bone Anchored Hearing Aids (BAHA) | listed, no stance | Aug 1, 2026 | payer document |
Prior authorization required or conditional in FL, ND, VA, WA.
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.