92568 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 92568

Payer coverage policies that name 92568

92568 appears in 7 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Centene.

PayerPolicyRole in policyReviewedDocument
AetnaAlzheimer's Disease Tests (0349)not coveredAug 4, 2026payer document
AetnaAttention Deficit/Hyperactivity Disorder (0426)
EEG theta/beta power ratio, Gut microbiota profile, polygenic risk score, evaluation of kynurenine pathway
not coveredJul 7, 2026payer document
AetnaAuditory Processing Disorder (APD) (0668)not covered (range 92551-92588)Oct 7, 2026payer document
AetnaAutism Spectrum Disorders (0648)not covered (range 92568-92569)Oct 2, 2025payer document
AetnaMultiple Sclerosis (0264)not coveredSep 10, 2026payer document
Blue Cross & Blue Shield of Rhode IslandEvaluation of Hearing Impairment/Loss
MEDICAL COVERAGE POLICY | 2
covered if criteria are metJun 3, 2026payer document
CenteneAttention Deficit Hyperactivity Disorder Assessment and Treatment (CP.BH.124)not coveredMar 1, 2024payer document

Medicaid fee-for-service

Prior authorization required or conditional in WV.

  • AZ: $24.53 (outpatient_hospital), effective Oct 1, 2021
  • CO: $12.36 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $9.94 (hearing, facility), effective Apr 6, 2026
  • IL: $13.33 (audiology), effective Jan 1, 2026
  • IN: $11.91 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $9.61 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $10.63 (audiology), effective Jan 1, 2026
  • LA: $22.50 (epsdt), effective Mar 1, 2004
  • MA: $11.25 (physician_medicine, facility), effective May 1, 2024
  • MS: $11.01 (comprehensive), effective Jul 1, 2026
  • ND: $16.90 (physician), effective Aug 1, 2026
  • NE: $9.14 (physician, non-facility), effective Jul 1, 2026
  • NY: $10.80 (hearing_aid, facility), effective Jul 1, 2026
  • OH: $11.58 (physician), effective Jan 1, 2024
  • OK: $33.63 (outpatient_hospital_apc), effective Jan 1, 2026
  • TX: $12.63 (audiologist, Audiologist, non-facility), effective Sep 1, 2025
  • VA: $11.00 (medical, facility), effective Jul 1, 2026
  • VT: $29.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $7.45 (neurodevelopmental_centers, facility), effective Jul 1, 2026
  • WY: $16.52 (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.