95120 CPT® code: payer coverage and prior authorization95120 appears in 6 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, BlueCross BlueShield of South Carolina.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Allergy and Hypersensitivity (0038) | covered if criteria are met (range 95115-95170) | Mar 10, 2026 | payer document |
| Aetna | Tezepelumab-ekko (Tezspire) (1003) | listed, no stance (range 95115-95199) | Aug 6, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Allergy Immunotherapy (L.2.01.414) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Allergy Immunotherapy Injections Claims filed with the below codes will deny as Use Alternate Code | covered if criteria are met | Mar 5, 2025 | payer document |
| Blue Cross NC | Allergy Immunotherapy (Desensitization) | listed, no stance | Nov 1, 2025 | payer document |
| BlueCross BlueShield of South Carolina | Allergy Immunotherapy (CAM 009) | listed, no stance | Oct 1, 2025 | 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.