Payer policies › CPT 7809978099 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 78099 12 of 13 payer prior-auth lists that name 78099 require prior authorization or set conditions: Humana, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Nevada, Molina Healthcare of Ohio, Molina Healthcare of Texas, Rocky Mountain Health Plans, UnitedHealthcare, UnitedHealthcare Community Plan.
Payer Plan State Prior auth Conditions Since Source Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management 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 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 Texas Exchange TX prior auth required Sep 1, 2019 Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 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 UnitedHealthcare Connected (Texas MMP) TX prior auth required Jan 1, 2015 Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U
Payer coverage policies that name 78099 78099 appears in 2 coverage policies from Blue Cross & Blue Shield of Mississippi, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Blue Cross & Blue Shield of Mississippi Miscellaneous Noncardiac Nononcologic Applications Of Fluorine 18 Fluorodeoxyglucose Positron Emission Tomography unproven / investigational payer document UnitedHealthcare Radiologic Diagnostic Procedures (MMP076.18)Other Nuclear Medicine listed, no stance Sep 1, 2026 payer document
Recent prior-auth changes Feb 1, 2026: PA removed, Rocky Mountain Health Plans Feb 1, 2026: PA removed, UnitedHealthcare Community Plan Feb 1, 2026: PA removed, Rocky Mountain Health Plans Jan 1, 2026: PA removed, UnitedHealthcare Jan 1, 2026: PA removed, UnitedHealthcare Community Plan Jan 1, 2026: PA removed, Molina Healthcare of Michigan Jan 1, 2026: PA removed, Oxford Health Plans Jan 1, 2026: PA removed, UnitedHealthcare Community Plan Jan 1, 2026: PA removed, UnitedHealthcare Community Plan Jan 1, 2026: PA removed, UnitedHealthcare Community Plan Medicaid fee-for-service Prior authorization required or conditional in FL, KY, VT, WV, WY.
AZ: $150.78 (asc), effective Oct 1, 2026 IN: $0.00 (professional, facility), effective Jan 1, 2010 KS: $63.44 (asc, facility), effective Jan 1, 2013 KY: $215.08 (asc), effective Jan 1, 2026 MS: $173.41 (comprehensive, facility), effective Oct 1, 2025 ND: $0.00 (physician), effective Aug 1, 2026 OK: $0.00 (physician, non-facility), effective Jul 1, 2026 TX: $506.31 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2026 VT: $310.41 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $176.79 (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.