77336 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 77336

7 of 14 payer prior-auth lists that name 77336 require prior authorization or set conditions: Cigna, HealthSpring, Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Michigan.

PayerPlanStatePrior authConditionsSinceSource
CignaACA/IFPAllprior auth requiredMay be delegated to eviCore for some clientsAug 1, 2012Master Precertification List (For Health Care Providers)
CignaBasic StandardAllprior auth requiredMay be delegated to eviCore for some clientsAug 1, 2012Master Precertification List (For Health Care Providers)
CignaComplete/PHS+/PreferredAllprior auth requiredMay be delegated to eviCore for some clientsAug 1, 2012Master Precertification List (For Health Care Providers)
HealthSpringMedicare AdvantageAllprior auth requiredJan 1, 20252026 Q4 Prior Authorization List
Molina Healthcare of CaliforniaMedicaidCAprior auth requiredApr 1, 2026Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of IllinoisMedicaidILprior auth requiredApr 1, 2023Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of MichiganMedicaidMIprior auth under conditionsadults via Evolent; no PA for pediatricsJul 1, 2026Molina Healthcare of Michigan PA Matrix 2026-Q3

Payer coverage policies that name 77336

77336 appears in 6 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaCemiplimab-rwlc (Libtayo) (0942)listed, no stance (range 77261-77799)Jun 12, 2026payer document
AetnaGrowth Hormone (GH) and Growth Hormone Antagonists (0170)listed, no stance (range 77261-77799)Jun 26, 2026payer document
AetnaHematopoietic Cell Transplantation for Selected Childhood Solid Tumors (0496)listed, no stance (range 77261-77799)Aug 6, 2026payer document
AetnaInfertility (0327)listed, no stance (range 77261-77790)Jul 16, 2026payer document
AetnaIntraoperative Radiation Therapy (IORT) (0721)listed, no stance (range 77300-77399)Oct 20, 2025payer document
AetnaStrontium Chloride Sr-89 (0361)listed, no stance (range 77261-77525)Jan 9, 2026payer document

Recent prior-auth changes

  • Jan 1, 2026: PA added, Molina Healthcare of Michigan
  • Jul 1, 2024: conditions changed, Molina Healthcare of Illinois
  • Feb 1, 2024: PA removed, Blue Shield of California Promise Health Plan

Medicaid fee-for-service

  • AZ: $40.26 (asc), effective Oct 1, 2026
  • CO: $72.86 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $35.34 (radiology, non-facility), effective Jan 1, 2026
  • IN: $68.62 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $49.84 (default, Exempt Physician), effective Jan 1, 2024
  • KY: $71.81 (asc), effective Jan 1, 2026
  • LA: $66.78 (lab_radiology), effective Jul 1, 2025
  • MA: $68.56 (physician_radiology), effective May 1, 2024
  • MS: $56.90 (comprehensive, facility), effective Oct 1, 2025
  • ND: $102.13 (physician), effective Aug 1, 2026
  • NE: $124.97 (physician, non-facility), effective Jul 1, 2026
  • NY: $42.22 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $52.83 (physician), effective Jan 1, 2024
  • OK: $65.51 (asc), effective Jan 1, 2026
  • TX: $76.90 (miscellaneous_other_professionals_radiation_treatment_center, Miscellaneous Other Professionals - Radiation Treatment Center, facility), effective Mar 1, 2026
  • VA: $79.86 (medical), effective Jul 1, 2026
  • VT: $104.36 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $57.71 (physician, facility), effective Jul 1, 2026
  • WY: $59.44 (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.