93304 CPT® code: payer coverage and prior authorization14 of 21 payer prior-auth lists that name 93304 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Molina Healthcare of Washington.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| 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) |
| Molina Healthcare of California | Medicare Advantage | CA | prior auth required | Jul 1, 2021 | Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021 | |
| Molina Healthcare of California | Medicaid | CA | prior auth required | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 | |
| Molina Healthcare of Florida | Medicare Advantage | FL | prior auth required | vendor review only eviCore in IL/MI/OH/NY/WI | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021 |
| Molina Healthcare of Idaho | Medicare Advantage | ID | prior auth required | vendor review only eviCore in IL/MI/OH/NY/WI | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021 |
| Molina Healthcare of Illinois | Medicaid | IL | prior auth required | Jan 1, 2022 | Molina Healthcare of Illinois Codification Grid Q3 2026 | |
| Molina Healthcare of Michigan | Exchange | MI | prior auth required | Contact eviCore for PA | Jul 1, 2021 | Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 |
| Molina Healthcare of Michigan | Medicaid | MI | prior auth under conditions | adults via Evolent; no PA for pediatrics | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 |
| Molina Healthcare of Michigan | Medicare Advantage | MI | prior auth required | adults via Evolent | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 |
| 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 Texas | Exchange | TX | prior auth required | Jul 1, 2021 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 | |
| Molina Healthcare of Utah | Medicare Advantage | UT | prior auth required | vendor review only eviCore in IL/MI/OH/NY/WI | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021 |
| Molina Healthcare of Washington | Medicare Advantage | WA | prior auth required | vendor review only eviCore in IL/MI/OH/NY/WI | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021 |
93304 appears in 8 coverage policies from Aetna, Cigna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Balloon Valvuloplasty (0477) | listed, no stance (range 93303-93350) | Jul 17, 2026 | payer document |
| Aetna | Color-Flow Doppler Echocardiography and Myocardial Strain Imaging (0008) | listed, no stance | Mar 10, 2026 | payer document |
| Aetna | Magnetic Resonance Imaging of the Cardiovascular System - Cardiac MRI (0520) | listed, no stance (range 93303-93355) | Aug 20, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | listed, no stance (range 92920-93799) | Jul 23, 2026 | payer document |
| Aetna | Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) (0558) | listed, no stance (range 93303-93350) | Aug 21, 2026 | payer document |
| Aetna | Tilt Table Testing (0299) | listed, no stance (range 93303-93356) | May 15, 2026 | payer document |
| Cigna | Transthoracic Echocardiography in Adults (0510) | covered if criteria are met | Sep 15, 2026 | payer document |
| Cigna | Transthoracic Echocardiography in Children (0523) | covered if criteria are met | Sep 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.