93296 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 93296

2 of 5 payer prior-auth lists that name 93296 require prior authorization or set conditions: Molina Healthcare of Ohio.

PayerPlanStatePrior authConditionsSinceSource
Molina Healthcare of OhioMedicaid and MyCare Ohio (MMP) MedicaidOHprior auth under conditionsno PA under 18Oct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of OhioExchangeOHprior auth under conditionsno PA under 18Oct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01

Payer coverage policies that name 93296

93296 appears in 6 coverage policies from Aetna, Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).

PayerPolicyRole in policyReviewedDocument
AetnaBody Surface Potential Mapping (0705)listed, no stanceNov 24, 2025payer document
AetnaCardiovascular Monitoring Equipment for Home Use: Pulse, Blood Pressure, Telemonitors, and Pacemaker Monitors (0548)covered if criteria are metAug 21, 2026payer document
AetnaLeadless Cardiac Pacemaker (0893)covered if criteria are metDec 22, 2025payer document
AetnaNerve Blocks (0863)listed, no stance (range 92920-93799)Jul 23, 2026payer document
Blue Shield of California| Implantable Cardioverter Defibrillators (7.01.44)listed, no stancepayer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Implantable Cardioverter Defibrillators (SUR707.003)
CPT Codes 0571T, 0572T, 0573T, 0574T, 0575T, 0576T, 0577T, 0578T, 0579T, 0580T,
listed, no stanceDec 15, 2025payer document

Medicaid fee-for-service

  • AZ: $26.93 (outpatient_hospital), effective Oct 1, 2021
  • CO: $16.96 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $16.85 (physician, non-facility), effective Jan 1, 2026
  • IL: $19.27 (practitioner), effective Apr 1, 2024
  • IN: $15.09 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $17.76 (default, Exempt Physician), effective Jan 1, 2009
  • KY: $29.97 (physician, facility), effective Jan 1, 2026
  • MA: $17.88 (physician_medicine), effective May 1, 2024
  • MS: $28.34 (comprehensive), effective Jul 1, 2026
  • ND: $35.30 (physician), effective Aug 1, 2026
  • NE: $32.90 (physician, non-facility), effective Jul 1, 2026
  • OH: $21.95 (physician), effective Sep 1, 2013
  • OK: $26.49 (physician, non-facility), effective Jul 1, 2026
  • TX: $15.49 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2025
  • VA: $27.49 (medical), effective Jul 1, 2026
  • VT: $28.98 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $20.07 (physician, facility), effective Jul 1, 2026
  • WY: $16.50 (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.