Payer policies › CPT 9260792607 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 92607 9 of 9 payer prior-auth lists that name 92607 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Humana, UnitedHealthcare Community Plan.
Payer Plan State Prior auth Conditions Since Source 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 FL prior auth required Jan 1, 2027 1102002FL1026 FLHN8CBEN Humana Healthy Horizons in Florida Preauthorization and Notification List Humana Humana Healthy Horizons IL prior auth required Jan 1, 2027 Humana Healthy Horizons in Illinois Prior Authorization and Notification List To view -specific medical coverage policies, please visit Humana Healthy Horizons in Illinois Clinical coverage policies . UnitedHealthcare Community Plan AHCCCS Complete Care (ACC) AZ prior auth required Oct 1, 2026 Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026 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 ALTCS Long Term Care AZ prior auth required Oct 1, 2026 Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026 UnitedHealthcare Community Plan Nebraska Heritage Health NE prior auth required Jul 1, 2026 Prior authorization requirements for UnitedHealthcare Community Plan of Nebraska Effective July 1, 2026 General Information This list contains prior authorization requirements for participating United UnitedHealthcare Community Plan New Mexico Turquoise Care NM prior auth required Oct 1, 2026 Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026
Payer coverage policies that name 92607 92607 appears in 7 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Blue Shield of California, Capital Blue Cross.
Payer Policy Role in policy Reviewed Document Aetna Autism Spectrum Disorders (0648) covered if criteria are met Oct 2, 2025 payer document Aetna Speech Generating Devices (0437) covered if criteria are met Jul 1, 2026 payer document Blue Cross & Blue Shield of Mississippi Prosthetics (L.1.04.401) 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 Cochlear Implant listed, no stance Aug 1, 2026 payer document Blue Shield of California | Cochlear Implant (7.01.05) listed, no stance payer document Capital Blue Cross Cochlear Implant (MP 1.023)Procedure Codes covered if criteria are met Sep 1, 2026 payer document
Recent prior-auth changes Jan 1, 2026: PA removed, Humana Nov 1, 2025: PA removed, Blue Cross and Blue Shield of Illinois Oct 1, 2025: PA removed, Blue Cross and Blue Shield of Illinois Medicaid fee-for-service Prior authorization required or conditional in IN, ND.
AZ: $401.42 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $103.63 (chp_plus, non-facility), effective Jul 1, 2026 IL: $82.03 (practitioner), effective Apr 1, 2024 IN: $98.29 (professional, Advanced Practice Nurse (85%), facility), effective Jan 10, 2026 KY: $76.32 (physician, facility), effective Jan 1, 2026 LA: $38.00 (epsdt), effective May 1, 2022 MA: $94.31 (physician_medicine), effective May 1, 2024 ND: $137.05 (physician), effective Aug 1, 2026 NE: $91.03 (physician, non-facility), effective Jul 1, 2026 NY: $80.91 (physician_medicine, facility), effective Jul 1, 2026 OH: $81.03 (physician), effective Jan 1, 2024 OK: $108.37 (physician, non-facility), effective Jul 1, 2026 VA: $105.90 (medical), effective Jul 1, 2026 VT: $103.67 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $74.34 (habilitative, facility), effective Jul 1, 2026 WY: $108.59 (professional), effective Jul 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.