89331 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 89331

3 of 3 payer prior-auth lists that name 89331 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Humana, UnitedHealthcare.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)Teamsters group (TYW)AZprior auth requiredSep 1, 2026Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026)
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
UnitedHealthcareUnitedHealthcare Mid-Atlantic Health PlansAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026

Payer coverage policies that name 89331

89331 appears in 7 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Cigna, Premera Blue Cross, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaInfertility (0327)covered if criteria are met (range 89250-89356)Jul 16, 2026payer document
Blue Cross & Blue Shield of Rhode IslandExpanded Fertility Servicescovered if criteria are metDec 3, 2025payer document
Blue Cross & Blue Shield of Rhode IslandInfertility Servicescovered if criteria are metDec 3, 2025payer document
Blue Cross NCInfertility Diagnosis and Treatment – B0006listed, no stanceMar 1, 2026payer document
CignaInfertility Services (0089)covered if criteria are metJun 15, 2025payer document
Premera Blue CrossInfertility and Assisted Reproduction Serviceslisted, no stanceMay 11, 2026payer document
UnitedHealthcareInfertility Diagnosis, Treatment, and Fertility Preservation (2026T0270NN)listed, no stanceJun 1, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • CO: $19.59 (lab_cdl), effective Oct 1, 2025
  • KY: $19.59 (lab), effective Jan 1, 2026
  • ND: $0.00 (physician), effective Aug 1, 2026
  • VA: $19.59 (medical), effective Jan 1, 2020
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 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.