69990 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 69990

1 of 1 payer prior-auth lists that name 69990 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross and Blue Shield of TexasTexas PA exemption (gold card), outpatient, fully insuredTXprior auth requiredGold-card exemption availableJul 1, 2026BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)

Payer coverage policies that name 69990

69990 appears in 1 coverage policy from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaBack Pain - Invasive Procedures (0016)listed, no stanceOct 6, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in VT.

  • AZ: $219.66 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $167.77 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $154.04 (physician, non-facility), effective Jan 1, 2026
  • IN: $156.77 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $170.92 (default), effective Aug 1, 2024
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $178.18 (professional), effective Jul 1, 2025
  • MA: $0.00 (asc), effective May 1, 2026
  • MS: $162.47 (comprehensive), effective Jul 1, 2026
  • ND: $191.50 (physician), effective Aug 1, 2026
  • OH: $131.89 (physician), effective Jan 1, 2024
  • OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
  • TX: $168.36 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Mar 1, 2025
  • VA: $171.59 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $111.22 (physician, facility), effective Jul 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.