93005 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 93005

Payer coverage policies that name 93005

93005 appears in 14 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Rhode Island, Centene.

PayerPolicyRole in policyReviewedDocument
AetnaBody Surface Potential Mapping (0705)listed, no stance (range 93000-93278)Nov 24, 2025payer document
AetnaCardiac Computed Tomography (CT), Coronary CT Angiography, Calcium Scoring and CT Fractional Flow Reserve (0228)listed, no stanceJul 21, 2026payer document
AetnaCardiovascular Disease Risk Tests (0381)listed, no stanceAug 25, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 92920-93799)Jul 23, 2026payer document
AetnaSignal-Averaged Electrocardiography (SAECG) and Artificial Intelligence Algorithmic Electrocardiogram (0664)listed, no stance (range 93000-93010)Oct 7, 2026payer document
AetnaT-Wave Alternans (0579)listed, no stance (range 93000-93010)Sep 2, 2026payer document
AetnaTilt Table Testing (0299)listed, no stanceMay 15, 2026payer document
AetnaTranscranial Magnetic Stimulation and Cranial Electrical Stimulation (0469)not coveredJul 17, 2026payer document
AetnaWeight Reduction Programs and Devices (0039)listed, no stance (range 93000-93010)Mar 10, 2026payer document
AnthemPreoperative Testing for Low Risk Invasive Procedures and Surgeries (CG-MED-61)covered if criteria are metAug 13, 2026payer document
AnthemResting Electrocardiogram Screening in Adults (CG-MED-62)not coveredAug 13, 2026payer document
Blue Cross & Blue Shield of Rhode IslandAmbulance Services - Groundcovered if criteria are metSep 17, 2025payer document
CenteneAttention Deficit Hyperactivity Disorder Assessment and Treatment (CP.MP.124)not coveredFeb 1, 2022payer document
CenteneAttention Deficit Hyperactivity Disorder Assessment and Treatment (CP.BH.124)not coveredMar 1, 2024payer document

Medicaid fee-for-service

  • AZ: $25.99 (outpatient_hospital), effective Oct 1, 2022
  • CO: $5.33 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $5.34 (physician, non-facility), effective Jan 1, 2026
  • IL: $5.67 (practitioner), effective Apr 1, 2024
  • IN: $4.70 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $10.94 (default, Exempt Physician), effective Jan 1, 2000
  • KY: $12.26 (physician, facility), effective Jan 1, 2026
  • LA: $7.50 (professional), effective Feb 1, 2013
  • MA: $5.02 (physician_medicine), effective May 1, 2024
  • MS: $44.80 (comprehensive), effective Jul 1, 2026
  • ND: $7.51 (physician), effective Aug 1, 2026
  • NE: $21.93 (physician, non-facility), effective Jul 1, 2026
  • NY: $7.58 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $5.92 (physician), effective Jan 1, 2024
  • OK: $5.83 (physician, non-facility), effective Jul 1, 2026
  • TX: $5.33 (healthy_texas_women, Clinic/Group Practice, non-facility), effective Sep 1, 2021
  • VA: $6.08 (medical), effective Jul 1, 2026
  • VT: $45.81 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $4.40 (kidneycenters), effective Jul 1, 2026
  • WY: $26.09 (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.