Payer policies › CPT 7601976019 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 76019 1 of 1 payer prior-auth lists that name 76019 require prior authorization or set conditions: Blue Shield of California Promise Health Plan.
Payer Plan State Prior auth Conditions Since Source Blue Shield of California Promise Health Plan Promise Health Plan Medi-Cal CA prior auth required Sep 1, 2026 Medi-Cal Prior Authorization List
Payer coverage policies that name 76019 76019 appears in 1 coverage policy from Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Premera Blue Cross Non-covered Services and ProceduresPage | 8 of 30 | ∞ listed, no stance Jun 1, 2026 payer document
Recent prior-auth changes Feb 1, 2025: PA added, Blue Shield of California Promise Health Plan Medicaid fee-for-service Prior authorization required or conditional in IN.
AZ: $18.98 (asc), effective Oct 1, 2026 CO: $22.52 (chp_plus, non-facility), effective Jul 1, 2026 IN: $92.91 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KY: $118.65 (physician, facility), effective Jan 1, 2026 LA: $98.06 (lab_radiology), effective Jan 1, 2025 ND: $19.48 (physician, facility), effective Aug 1, 2026 OH: $107.39 (physician), effective Jan 1, 2025 TX: $98.10 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, non-facility), effective Apr 1, 2025 VA: $132.81 (medical, facility), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $26.09 (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.