71271 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 71271

36 of 37 payer prior-auth lists that name 71271 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, 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 Michigan, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of South Carolina, Molina Healthcare of Utah, Molina Healthcare of Washington, Molina Healthcare of Wisconsin, Molina Healthcare, Inc. (national grid), Oxford Health Plans, and others.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)AZ Blue-administered Medicare Advantage (M2K)AZprior auth requiredSep 1, 2026AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)Federal Employee Program (FEP)AZprior auth under conditionsFEP Blue Focus onlySep 1, 2026Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)Standard PA code list (most commercial plans)AZprior auth under conditionseviCore-delegated groups only; Gold-card eligibleSep 1, 2026AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)State of Arizona employee group (SYD, S3Z)AZprior auth requiredGold-card eligibleSep 1, 2026State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)
AetnaMedicare AdvantageAllprior auth requiredNot required for Student Health or Allina Health | Aetna plans; Not required inpatient, in the ER or in observationOct 1, 2026Participating provider precertification list for Aetna®
AetnaCommercialAllprior auth requiredNot required for Student Health or Allina Health | Aetna plans; Not required inpatient, in the ER or in observationOct 1, 2026Participating provider precertification list for Aetna®
Blue Cross and Blue Shield of IllinoisBlue Cross Community Health Plans (BCCHP), Illinois MedicaidILprior auth requiredCarelon-managedAug 1, 2025Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026
Blue Cross and Blue Shield of IllinoisBlue Cross Community MMAI (Medicare-Medicaid Alignment Initiative)ILprior auth requiredeviCore-managedApr 1, 2021Procedure Code List, Effective 1/1/2025
Blue Cross and Blue Shield of New MexicoTurquoise Care (New Mexico Medicaid)NMprior auth requiredCarelon-managedJan 1, 2021New Mexico Medicaid Benefit Preauthorization Procedure Code List 10/1/26
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)
HealthSpringMedicare AdvantageAllprior auth requiredJan 1, 20252026 Q4 Prior Authorization List
Molina Complete Care (Virginia)Medicare-only PA matrix for D-SNPVAprior auth requiredJan 1, 2022Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022
Molina Healthcare of ArizonaMedicare-only PA matrix for D-SNPAZprior auth requiredJan 1, 2022Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022
Molina Healthcare of CaliforniaMedicare AdvantageCAprior auth requiredJul 1, 2021Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021
Molina Healthcare of FloridaMedicare AdvantageFLprior auth requiredvendor review only eviCore in IL/MI/OH/NY/WIApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021
Molina Healthcare of IdahoMedicare AdvantageIDprior auth requiredvendor review only eviCore in IL/MI/OH/NY/WIApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021
Molina Healthcare of MichiganExchangeMIprior auth requiredContact eviCore for PAJul 1, 2021Molina Healthcare of Michigan PA Matrix, effective 7/1/2021
Molina Healthcare of NevadaMedicaidNVprior auth requiredOct 1, 2022Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022
Molina Healthcare of New MexicoMedicare AdvantageNMprior auth requiredJan 1, 2021Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021
Molina Healthcare of South CarolinaMedicare AdvantageSCprior auth requiredApr 1, 2021Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021
Molina Healthcare of UtahMedicare AdvantageUTprior auth requiredvendor review only eviCore in IL/MI/OH/NY/WIApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021
Molina Healthcare of WashingtonMedicare AdvantageWAprior auth requiredvendor review only eviCore in IL/MI/OH/NY/WIApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021
Molina Healthcare of WisconsinMedicare AdvantageWIprior auth requiredOct 1, 2021Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021
Molina Healthcare, Inc. (national grid)Molina national (MHI) Medicare gridAllprior auth requiredOct 1, 2021Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021
Oxford Health PlansOxford Health PlansAllprior auth requiredsite of care: site of service reviewedOct 1, 2026Prior Authorization Requirements for Oxford Effective October 1, 2026
Rocky Mountain Health PlansRocky Mountain Health Plans CHP+COprior auth requiredOct 1, 2026Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026
Rocky Mountain Health PlansRocky Mountain Health Plans Prime / RAECOprior auth requiredOct 1, 2026Rocky Mountain Health Plans PRIME Effective October 1, 2026
Rocky Mountain Health PlansRocky Mountain Medicare Advantage D-SNPCOprior auth requiredFeb 1, 2025Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth requiredSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Individual Exchange plansAllprior auth requiredsite of care: site of service reviewedOct 1, 2026Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcare Community PlanNorth Carolina MedicaidNCprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of North Carolina Effective October 1, 2026 July 1, 2024
UnitedHealthcare Community PlanTennCareTNprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Tennessee Effective October 1, 2026
UnitedHealthcare Community PlanTexas CHIPTXprior auth requiredAug 1, 2024Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care
UnitedHealthcare Community PlanTexas STARTXprior auth requiredAug 1, 2024Prior authorization requirements for Texas STAR Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR h
UnitedHealthcare Community PlanTexas STAR KidsTXprior auth requiredAug 1, 2024Prior authorization requirements for STAR Kids Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR Ki
UnitedHealthcare Community PlanTexas STAR+PLUSTXprior auth requiredAug 1, 2024Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p

Payer coverage policies that name 71271

71271 appears in 7 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, BlueCross BlueShield of South Carolina, Premera Blue Cross, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaLung Cancer Screening (0380)listed, no stanceMay 28, 2026payer document
AetnaLung Imaging: Selected Techniques (0581)listed, no stanceSep 10, 2026payer document
Blue Cross & Blue Shield of MississippiScreening For Lung Cancer Using Computed Tomography Ct Scanning (L.2.01.411)covered if criteria are metpayer document
BlueCross BlueShield of South CarolinaLow-Dose CT for Lung Cancer Screening (CAM 391)listed, no stanceJan 1, 2026payer document
Premera Blue CrossPreventive Care
Lung cancer screening (CT scan) for those at higher risk
covered if criteria are metSep 21, 2026payer document
UnitedHealthcareMagnetic Resonance Imaging (MRI) and Computed Tomography (CT) Scan – Site of Service (MP.13.20)
Computed Tomography
listed, no stanceSep 1, 2026payer document
UnitedHealthcareOutpatient Radiology Procedures for EviCore Arrangement (for Oxford Only) (RADIOLOGY)
Dates of Service
listed, no stanceSep 1, 2026payer document

Recent prior-auth changes

  • Mar 1, 2026: conditions changed, UnitedHealthcare
  • Jan 1, 2026: PA removed, Molina Healthcare of Michigan
  • Dec 1, 2025: PA added, UnitedHealthcare Community Plan
  • Apr 1, 2025: PA removed, UnitedHealthcare Community Plan
  • Mar 1, 2025: PA added, UnitedHealthcare Community Plan
  • Mar 1, 2025: PA added, UnitedHealthcare Community Plan
  • Mar 1, 2025: PA added, UnitedHealthcare Community Plan
  • Mar 1, 2025: PA removed, uhc:pa:summary-of-changes
  • Mar 1, 2025: PA removed, uhc:pa:summary-of-changes
  • Mar 1, 2025: PA removed, uhc:pa:summary-of-changes

Medicaid fee-for-service

Prior authorization required or conditional in CO, FL, MS, WA, WV.

  • AZ: $79.00 (outpatient_hospital), effective Oct 1, 2023
  • CO: $41.51 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $67.54 (radiology), effective Jan 1, 2026
  • IL: $91.46 (practitioner), effective Apr 1, 2024
  • IN: $40.25 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $31.62 (default, Exempt Physician), effective Jan 1, 2024
  • KY: $45.00 (asc), effective Jan 1, 2026
  • LA: $95.86 (lab_radiology), effective Jan 1, 2021
  • MA: $38.09 (physician_radiology), effective May 1, 2024
  • MS: $67.22 (comprehensive), effective Jul 1, 2026
  • ND: $151.32 (physician), effective Aug 1, 2026
  • NE: $515.74 (physician, non-facility), effective Jul 1, 2026
  • NY: $35.18 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $111.22 (physician), effective Jan 1, 2024
  • OK: $117.17 (physician, non-facility), effective Jul 1, 2026
  • TX: $131.99 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025
  • VA: $118.06 (medical, facility), effective Jul 1, 2026
  • VT: $81.18 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $54.65 (physician, facility), effective Jul 1, 2026
  • WY: $46.23 (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.