Payer policies › CPT 9364193641 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 93641 14 of 21 payer prior-auth lists that name 93641 require prior authorization or set conditions: CarePlus Health Plans, Humana, Molina Healthcare of Ohio.
Payer Plan State Prior auth Conditions Since Source CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services Humana Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services Humana Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management 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
Payer coverage policies that name 93641 93641 appears in 7 coverage policies from Aetna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
Payer Policy Role in policy Reviewed Document Aetna Body Surface Potential Mapping (0705) listed, no stance Nov 24, 2025 payer document Aetna Cardioverter-Defibrillators (0585) listed, no stance Apr 22, 2026 payer document Aetna Maze Procedure (0225) listed, no stance (range 93600-93660) Jun 29, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance (range 92920-93799) Jul 23, 2026 payer document Aetna T-Wave Alternans (0579) listed, no stance (range 93600-93662) Sep 2, 2026 payer document Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure (MED202.054)CPT Codes 33202, 33203, 33207, 33208, 33211, 33213, 33214, 33217, 33220, listed, no stance Oct 1, 2026 payer 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 stance Dec 15, 2025 payer document
Recent prior-auth changes Jan 1, 2026: PA removed, Molina Healthcare of Michigan Jan 1, 2026: PA removed, Molina Healthcare of Illinois Jul 1, 2024: conditions changed, Molina Healthcare of Illinois Jan 1, 2024: PA added, Molina Healthcare of Michigan Medicaid fee-for-service AZ: $349.08 (physician, AHCCCS PT 08, facility), effective Oct 1, 2020 CO: $240.67 (chp_plus, non-facility), effective Jul 1, 2026 FL: $177.64 (physician), effective Jan 1, 2026 IL: $383.22 (practitioner), effective Apr 1, 2024 IN: $226.42 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KY: $571.97 (physician, facility), effective Jan 1, 2026 LA: $164.09 (professional), effective Feb 1, 2013 MA: $222.16 (physician_medicine), effective May 1, 2024 MS: $840.36 (comprehensive), effective Jul 1, 2026 ND: $313.54 (physician), effective Aug 1, 2026 NE: $987.12 (physician, non-facility), effective Jul 1, 2026 NY: $485.00 (physician_medicine, facility), effective Jul 1, 2026 OH: $503.52 (physician), effective Jan 1, 2000 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $447.25 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), facility), effective Sep 1, 2025 VA: $0.00 (medical), effective Jul 1, 2011 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $312.86 (physician, facility), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.