91034 CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 91034 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jul 1, 2026 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
91034 appears in 8 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, BlueCross BlueShield of South Carolina, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Esophageal and Airway pH Monitoring (0667) | listed, no stance | Oct 7, 2026 | payer document |
| Anthem | Esophageal pH Monitoring (CG-MED-02) | covered if criteria are met | Aug 13, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Esophageal Ph Monitoring | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Esophageal pH Monitoring | covered if criteria are met | Mar 4, 2026 | payer document |
| Blue Cross Blue Shield of Massachusetts | Esophageal pH Monitoring (069) | listed, no stance | payer document | |
| Blue Cross NC | Esophageal pH Monitoring | listed, no stance | Mar 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Esophageal pH Monitoring (CAM 20120) | listed, no stance | Jul 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Esophageal pH Monitoring (MED201.005) | listed, no stance | Jan 1, 2026 | payer document |
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.