90887 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 90887

Payer coverage policies that name 90887

90887 appears in 2 coverage policies from Aetna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).

PayerPolicyRole in policyReviewedDocument
AetnaEye Movement Desensitization and Reprocessing (EMDR) Therapy (0583)listed, no stance (range 90832-90899)Sep 18, 2026payer 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 stanceJan 1, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • AZ: $14.64 (outpatient_hospital, RF133), effective Oct 1, 2025
  • CO: $70.64 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $49.18 (physician, facility), effective Jan 1, 2026
  • KY: $0.00 (asc), effective Jan 1, 2026
  • MA: $53.50 (physician_medicine, facility), effective May 1, 2024
  • ND: $0.00 (physician), effective Aug 1, 2026
  • NE: $31.68 (behavioral_health, Advanced Practice Registered Nurse (APRN)), effective Jul 1, 2025
  • OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
  • VA: $0.00 (medical), effective Oct 1, 1975
  • 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.