92523 CPT® code: payer coverage and prior authorization7 of 7 payer prior-auth lists that name 92523 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Blue Shield of California, Humana, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Shield of California | Blue Shield commercial | CA | prior auth under conditions | CalPERS ASO only | Sep 1, 2026 | Prior Authorization List for Blue Shield |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative) | IL | prior auth required | eviCore-managed | Jan 1, 2025 | Procedure Code List, Effective 1/1/2025 |
| 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) |
| Humana | Humana Healthy Horizons | KY | prior auth required | Jan 1, 2027 | please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. | |
| UnitedHealthcare Community Plan | ALTCS Developmentally Disabled | AZ | prior auth required | Oct 1, 2026 | Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | New Jersey FamilyCare | NJ | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U | |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Florida | FL | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026 |
92523 appears in 30 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Attention Deficit/Hyperactivity Disorder (0426) EEG theta/beta power ratio, Gut microbiota profile, polygenic risk score, evaluation of kynurenine pathway | not covered | Jul 7, 2026 | payer document |
| Aetna | Auditory Processing Disorder (APD) (0668) | not covered | Oct 7, 2026 | payer document |
| Aetna | Autism Spectrum Disorders (0648) | covered if criteria are met | Oct 2, 2025 | payer document |
| Aetna | Bone-Anchored Hearing Aids (0403) | listed, no stance | Jul 22, 2026 | payer document |
| Aetna | Cochlear Implants and Auditory Brainstem Implants (0013) | covered if criteria are met | Aug 18, 2026 | payer document |
| Aetna | Early Intervention Programs (0444) | not covered | Jul 1, 2026 | payer document |
| Aetna | Speech Generating Devices (0437) | covered if criteria are met | Jul 1, 2026 | payer document |
| Aetna | Speech Therapy (0243) | listed, no stance | May 13, 2026 | payer document |
| Aetna | Voice Therapy (0646) | listed, no stance | Sep 9, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Speech Therapy (L.8.03.402) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Speech Therapy | covered if criteria are met | Aug 5, 2026 | payer document |
| Blue Cross NC | Rehabilitative Therapies | listed, no stance | Sep 1, 2025 | payer document |
| Blue Shield of California | BSC8.02 | Speech Therapy | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Speech Therapy (CAM 80304) 92508 | group, 2 or more individuals | listed, no stance | Jun 1, 2026 | payer document |
| Centene | Skilled Nursing Facility Leveling (CP.MP.206) | covered if criteria are met | Aug 1, 2022 | 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 |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (MP.026.27) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (CS164.M) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Florida Only) (CS164FL.N) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Idaho Only) (CS164ID.C) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Kentucky Only) (CS164KY.10) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Nebraska Only) (CS164NE.K) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for New Jersey Only) (CS164NJ.H) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for New Mexico Only) (CS164NM.C) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for North Carolina Only) (CSNC.MP.164.05) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Ohio Only) (CS164OH.D) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Pennsylvania Only) (CS164PA.E) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) – Site of Service (for Florida Only) (CS161FL.M) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Home Health, Skilled, and Custodial Care Services (for North Carolina Only) (CSNC.MP.022.08) | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in LA, ND, VA, WV.
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.