Payer policies › CPT 8933589335 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 89335 13 of 13 payer prior-auth lists that name 89335 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Cigna, Humana, Molina Healthcare of Texas, Neighborhood Health Partnership, Oxford Health Plans, Surest, UnitedHealthcare.
Payer Plan State Prior auth Conditions Since Source Blue Cross Blue Shield of Arizona (AZ Blue) Federal Employee Program (FEP) AZ prior auth under conditions FEP Standard Plan only Sep 1, 2026 Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) Blue Cross Blue Shield of Arizona (AZ Blue) Teamsters group (TYW) AZ prior auth required Sep 1, 2026 Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026) Cigna ACA/IFP All prior auth required Oct 1, 2006 Master Precertification List (For Health Care Providers) Cigna Complete/PHS+/Preferred All prior auth required Oct 1, 2006 Master Precertification List (For Health Care Providers) Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management Molina Healthcare of Texas Exchange TX prior auth required Jan 1, 2025 Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 Neighborhood Health Partnership Neighborhood Health Partnership FL prior auth required Sep 1, 2026 Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 Oxford Health Plans Oxford Health Plans All prior auth required Oct 1, 2026 Prior Authorization Requirements for Oxford Effective October 1, 2026 Surest Surest health plans All prior auth required Oct 1, 2026 Prior Authorization Requirements for Surest Effective October 1, 2026 UnitedHealthcare UnitedHealthcare Commercial All prior auth required Oct 1, 2026 Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026 UnitedHealthcare UnitedHealthcare Individual Exchange plans All prior auth under conditions not in NM, SC, WI Oct 1, 2026 Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 UnitedHealthcare UnitedHealthcare West commercial plans All prior auth required Oct 1, 2026 Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026 UnitedHealthcare UnitedHealthcare of the River Valley All prior auth required Oct 1, 2026 Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026
Payer coverage policies that name 89335 89335 appears in 10 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Infertility (0327) covered if criteria are met (range 89250-89356) Jul 16, 2026 payer document Anthem Assisted Reproductive Technology (CG-MED-103) covered if criteria are met Nov 6, 2025 payer document Blue Cross & Blue Shield of Rhode Island Expanded Fertility Services covered if criteria are met Dec 3, 2025 payer document Blue Cross & Blue Shield of Rhode Island Infertility Services not covered Dec 3, 2025 payer document Blue Cross Blue Shield of Massachusetts Assisted Reproductive Servies Infertility Services (086) listed, no stance payer document Blue Shield of California | Reproductive Techniques (4.02.04) listed, no stance payer document Cigna Infertility Services (0089) unproven / investigational Jun 15, 2025 payer document Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) Reproductive Techniques and Immunotherapy for Recurrent Fetal Loss (OB402.023)CPT Codes 55899, 58322, 58340, 58999, 76831, 82397, 83519, 83520, 86148, 86357, listed, no stance Jan 1, 2026 payer document Premera Blue Cross Infertility and Assisted Reproduction Services listed, no stance May 11, 2026 payer document UnitedHealthcare Infertility Diagnosis, Treatment, and Fertility Preservation (2026T0270NN) listed, no stance Jun 1, 2026 payer document
Recent prior-auth changes Mar 1, 2026: PA removed, UnitedHealthcare Sep 1, 2025: conditions changed, UnitedHealthcare May 1, 2025: conditions changed, UnitedHealthcare Dec 1, 2024: conditions changed, UnitedHealthcare Medicaid fee-for-service Prior authorization required or conditional in IN.
ND: $0.00 (physician), effective Aug 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $23.05 (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.