92609 CPT® code: payer coverage and prior authorization13 of 13 payer prior-auth lists that name 92609 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Humana, UnitedHealthcare Community Plan.
92609 appears in 19 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), UnitedHealthcare.
| 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 Rhode Island | Autism Spectrum Disorders Mandate | covered if criteria are met | Apr 15, 2026 | 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 |
| Centene | Skilled Nursing Facility Leveling (CP.MP.206) | covered if criteria are met | Aug 1, 2022 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Speech Generating Devices (SGD) (DME104.009) | listed, no stance | Sep 15, 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) (MP.026.27) | listed, no stance | Jul 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 |
Prior authorization required or conditional in CO, IN, ND.
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.