96110 CPT® code: payer coverage and prior authorization2 of 2 payer prior-auth lists that name 96110 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Molina Healthcare of California.
| 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 | Medicaid | CA | prior auth required | State exception | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 |
96110 appears in 5 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Cigna, Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Autism Spectrum Disorders (0648) | covered if criteria are met | Oct 2, 2025 | payer document |
| Aetna | Early Intervention Programs (0444) | listed, no stance | Jul 1, 2026 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Psychological and Neuropsychological Testing | listed, no stance | Jun 12, 2026 | payer document |
| Cigna | Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment (0447) | covered if criteria are met | May 15, 2026 | payer document |
| Premera Blue Cross | Preventive Care Fluoride supplements Developmental screening Including autism | covered if criteria are met | Sep 21, 2026 | payer document |
Prior authorization required or conditional in ND.
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.