92971 CPT® code: payer coverage and prior authorization8 of 10 payer prior-auth lists that name 92971 require prior authorization or set conditions: Molina Complete Care (Virginia), Molina Healthcare of Idaho, Molina Healthcare of Iowa, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of Ohio, Molina Healthcare of Utah.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Complete Care (Virginia) | Medicaid | VA | prior auth required | Apr 1, 2025 | Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 | |
| Molina Healthcare of Idaho | Medicaid | ID | prior auth required | Jan 1, 2025 | Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025 | |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Molina Healthcare of Mississippi | Medicaid | MS | prior auth required | adults via Evolent | Jan 1, 2025 | Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 |
| Molina Healthcare of Nevada | Medicaid | NV | prior auth required | adults via NCH | Oct 1, 2022 | Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 |
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth under conditions | no PA under 18 | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
| Molina Healthcare of Ohio | Exchange | OH | prior auth under conditions | no PA under 18 | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 |
| Molina Healthcare of Utah | Medicaid | UT | prior auth required | Jan 1, 2025 | Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025 |
92971 appears in 7 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Enhanced External Counterpulsation (EECP) (0262) | covered if criteria are met | May 14, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | listed, no stance (range 92920-93799) | Jul 23, 2026 | payer document |
| Aetna | Ventricular Assist Devices (0654) | covered if criteria are met | Sep 10, 2026 | payer document |
| Anthem | Enhanced External Counterpulsation in the Outpatient Setting (CG-MED-86) | covered if criteria are met | Nov 6, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | End Diastolic Pneumatic Compression Boot As A Treatment Of Peripheral Vascular Disease Or Lymphedema (L.2.02.405) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Enhanced External Counterpulsation (L.2.02.411) | unproven / investigational | payer document | |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | External Counterpulsation (ECP) Therapy for Severe Angina (MED202.050) | listed, no stance | May 15, 2026 | payer document |
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.