91132 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 91132

2 of 2 payer prior-auth lists that name 91132 require prior authorization or set conditions: Rocky Mountain Health Plans, UnitedHealthcare Community Plan.

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
UnitedHealthcare Community PlanUnitedHealthcare Connected (Texas MMP)TXprior auth requiredJan 1, 2015Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U

Payer coverage policies that name 91132

91132 appears in 17 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Capital Blue Cross, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaGastrointestinal Function: Selected Tests (0396)not coveredJul 9, 2026payer document
Blue Cross & Blue Shield of Rhode IslandElectrogastrography (EGG)not coveredJan 8, 2025payer document
Blue Cross & Blue Shield of Rhode IslandElectrogastrography (EGG) sanot coveredJan 7, 2026payer document
Blue Cross NCElectrogastrography, Cutaneouslisted, no stanceMar 1, 2026payer document
Capital Blue CrossExperimental and Investigational Procedures (MP 4.002)
Procedure codes: Lab services
listed, no stanceSep 1, 2026payer document
UnitedHealthcareGastroesophageal and Gastrointestinal (GI) Services and Procedures (MMP039.19)
Electrogastrography or Electroenterography
listed, no stanceJun 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (CS046.T)listed, no stanceJul 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (2026T0415II)listed, no stanceJun 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Idaho Only) (CS046ID.C)listed, no stanceAug 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Kansas Only) (CS046KS.04)listed, no stanceJul 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Kentucky Only) (CS046KY.12)listed, no stanceJul 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Nebraska Only) (CS046NE.T)listed, no stanceJul 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for New Jersey Only) (CS046NJ.R)listed, no stanceJul 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for New Mexico Only) (CS046NM.E)listed, no stanceJul 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Ohio Only) (CS046OH.F)listed, no stanceAug 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Pennsylvania Only) (CS046PA.S)listed, no stanceSep 1, 2026payer document
UnitedHealthcareGastrointestinal Disorders Diagnostic Procedures (for Tennessee Only) (CS046TN.S)listed, no stanceJul 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, Oxford Health Plans
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans

Medicaid fee-for-service

  • AZ: $191.73 (outpatient_hospital), effective Oct 1, 2021
  • CO: $99.40 (chp_plus, non-facility), effective Jul 1, 2026
  • IN: $297.49 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KY: $9.63 (physician, facility), effective Jan 1, 2026
  • LA: $328.88 (professional), effective Jul 1, 2025
  • MA: $356.43 (physician_medicine), effective May 1, 2024
  • MS: $355.07 (comprehensive), effective Jul 1, 2026
  • ND: $545.21 (physician), effective Aug 1, 2026
  • NE: $19.18 (physician, non-facility), effective Jul 1, 2026
  • OH: $112.52 (physician), effective Sep 1, 2013
  • OK: $194.44 (outpatient_hospital_apc), effective Jan 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $289.13 (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.