95873 CPT® code: payer coverage and prior authorization95873 appears in 24 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Atidarsagene Autotemcel (Lenmeldy) (1058) | listed, no stance (range 95860-95887) | Jul 13, 2026 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | not covered | Oct 6, 2026 | payer document |
| Aetna | Botulinum Toxin (0113) | covered if criteria are met | Jul 14, 2026 | payer document |
| Aetna | Chiropractic Services (0107) | listed, no stance (range 95860-95887) | Apr 7, 2026 | payer document |
| Aetna | Electrodiagnostic Testing (0502) | covered if criteria are met (range 95860-95887) | Jul 29, 2026 | payer document |
| Aetna | Facial Nerve Paralysis (0745) | not covered | Oct 30, 2025 | payer document |
| Aetna | Parenteral Immunoglobulins (0206) | listed, no stance (range 95860-95887) | Oct 8, 2026 | payer document |
| Aetna | Post-Herpetic Neuralgia (0725) | not covered | Oct 20, 2025 | payer document |
| Aetna | Vocal Cord Paralysis / Insufficiency Treatments (0253) | covered if criteria are met | Apr 15, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Botulinum Toxin (S.5.01.491) | not covered | payer document | |
| Blue Cross & Blue Shield of Mississippi | Botulinum Toxin (L.5.01.491) | not covered | payer document | |
| Blue Cross NC | Electrodiagnostic Studies | listed, no stance | Oct 1, 2025 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (2026T0493II) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (CS082.W) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (for Idaho Only) (CS082ID.C) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (for Kansas Only) (CS082KS.02) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (for Kentucky Only) (CS082KY.12) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (for Nebraska Only) (CS082NE.W) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (for New Jersey Only) (CS082NJ.T) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (for New Mexico Only) (CS082NM.C) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (for North Carolina Only) (CSNCT0152.08) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (for Ohio Only) (CS082OH.E) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (for Pennsylvania Only) (CS082PA.U) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Neurophysiologic Testing and Monitoring (for Tennessee Only) (CS082TN.U) | listed, no stance | Apr 1, 2026 | payer document |
Prior authorization required or conditional in WA.
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.