96170 CPT® code: payer coverage and prior authorization2 of 2 payer prior-auth lists that name 96170 require prior authorization or set conditions: Molina Healthcare of Michigan, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Healthcare of Michigan | Exchange | MI | prior auth required | Jul 1, 2021 | Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 | |
| UnitedHealthcare Community Plan | New Jersey FamilyCare | NJ | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U |
96170 appears in 7 coverage policies from Aetna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Alopecia Areata (0423) | not covered | Jul 10, 2026 | payer document |
| Aetna | Attention Deficit/Hyperactivity Disorder (0426) | covered if criteria are met | Jul 7, 2026 | payer document |
| Aetna | Autism Spectrum Disorders (0648) | covered if criteria are met (range 96158-96171) | Oct 2, 2025 | payer document |
| Aetna | Biofeedback (0132) | listed, no stance (range 96156-96171) | Jul 16, 2026 | payer document |
| Aetna | Chronic Pain Rehabilitation Programs (0237) | listed, no stance (range 96156-96171) | Apr 23, 2026 | payer document |
| Aetna | Eating Disorders (0511) | covered if criteria are met (range 96158-96171) | Aug 4, 2026 | payer document |
| Aetna | Pediatric Intensive Feeding Programs (0809) | listed, no stance (range 96158-96171) | Dec 11, 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.