91065 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 91065

1 of 1 payer prior-auth lists that name 91065 require prior authorization or set conditions: Rocky Mountain Health Plans.

PayerPlanStatePrior authConditionsSinceSource
Rocky Mountain Health PlansRocky Mountain Medicare Advantage D-SNPCOprior auth requiredFeb 1, 2025Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025

Payer coverage policies that name 91065

91065 appears in 4 coverage policies from Aetna, Blue Cross NC, BlueCross BlueShield of South Carolina, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaExhaled Breath Tests (0691)covered if criteria are metOct 16, 2025payer document
Blue Cross NCDiagnosis of Idiopathic Environmental Intolerance AHS - G2056listed, no stanceJan 1, 2026payer document
BlueCross BlueShield of South CarolinaDiagnosis and Management of Idiopathic Environmental Intolerance (i.e., Clinical Ecology) (CAM 267)
Code Number
listed, no stanceJan 1, 2026payer document
Premera Blue CrossDiagnosis of Idiopathic Environmental Intolerancelisted, no stanceFeb 6, 2026payer document

Recent prior-auth changes

  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans

Medicaid fee-for-service

  • AZ: $29.94 (asc), effective Oct 1, 2026
  • CO: $47.61 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $42.61 (physician), effective Jan 1, 2026
  • IL: $47.03 (practitioner), effective Apr 1, 2024
  • IN: $42.47 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $11.59 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $53.41 (asc), effective Jan 1, 2026
  • LA: $63.87 (professional), effective Jan 1, 2014
  • MA: $7.24 (physician_medicine), effective May 1, 2024
  • MS: $50.72 (comprehensive), effective Jul 1, 2026
  • ND: $52.83 (physician, facility), effective Aug 1, 2026
  • NE: $63.06 (physician, non-facility), effective Jul 1, 2026
  • NY: $25.25 (lab), effective Aug 1, 2026
  • OH: $47.07 (physician), effective Jan 1, 2024
  • OK: $8.73 (physician, non-facility), effective Jul 1, 2026
  • TX: $52.39 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, non-facility), effective Sep 1, 2025
  • VA: $47.45 (medical), effective Jul 1, 2026
  • VT: $167.66 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $5.73 (physician, facility), effective Jul 1, 2026
  • WY: $95.49 (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.