90792 CPT® code: payer coverage and prior authorization1 of 3 payer prior-auth lists that name 90792 require prior authorization or set conditions: Molina Healthcare of Ohio.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth under conditions | PA after limit is reached | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
90792 appears in 8 coverage policies from Aetna, BlueCross BlueShield of South Carolina, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Attention Deficit/Hyperactivity Disorder (0426) | covered if criteria are met | Jul 7, 2026 | payer document |
| Aetna | Chronic Pain Rehabilitation Programs (0237) | listed, no stance | Apr 23, 2026 | payer document |
| Aetna | Cognitive Rehabilitation (0214) | listed, no stance | Apr 21, 2026 | payer document |
| Aetna | Eating Disorders (0511) | covered if criteria are met (range 90791-90792) | Aug 4, 2026 | payer document |
| Aetna | Premenstrual Syndrome and Premenstrual Dysphoric Disorder (0512) | covered if criteria are met | Aug 5, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Telehealth (CAM 176) | listed, no stance (range 90791-90792) | Oct 1, 2025 | payer document |
| Cigna | Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment (0447) | covered if criteria are met | May 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Medical Policies Moving to MCG Guidelines Spectrum Disorders (ASD) | 70460, 70470, 70496, 70551, | Disorders – Gene Panels | listed, no stance | Jan 1, 2026 | payer document |
Prior authorization required or conditional in MS, OH.
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.