96365 CPT® code: payer coverage and prior authorization96365 appears in 137 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Abatacept (Orencia) (0720) | listed, no stance (range 96365-96368) | Jul 1, 2026 | payer document |
| Aetna | Ado-trastuzumab Emtansine (Kadcyla) (0974) | listed, no stance | Jan 21, 2026 | payer document |
| Aetna | Aducanumab-avwa (Aduhelm) (0996) | listed, no stance (range 96365-96368) | Dec 9, 2025 | payer document |
| Aetna | Aldesleukin (Proleukin) (0024) | listed, no stance (range 96365-96368) | Oct 9, 2026 | payer document |
| Aetna | Alopecia Areata (0423) | listed, no stance (range 96365-96367) | Jul 10, 2026 | payer document |
| Aetna | Anifrolumab-fnia (Saphnelo) (0997) | listed, no stance (range 96365-96368) | Jun 5, 2026 | payer document |
| Aetna | Atidarsagene Autotemcel (Lenmeldy) (1058) | listed, no stance | Jul 13, 2026 | payer document |
| Aetna | Attention Deficit/Hyperactivity Disorder (0426) | listed, no stance (range 96365-96368) | Jul 7, 2026 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 96365-96368) | Oct 6, 2026 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 96365-96366) | Oct 6, 2026 | payer document |
| Aetna | Belimumab (Benlysta) (0818) | listed, no stance | Jun 10, 2026 | payer document |
| Aetna | Betibeglogene Autotemcel (Zynteglo) (1016) | listed, no stance (range 96365-96368) | Dec 31, 2025 | payer document |
| Aetna | Bezlotoxumab (Zinplava) (0914) | listed, no stance (range 96365-96366) | Jan 7, 2026 | payer document |
| Aetna | Breast Biopsy Procedures (0269) | listed, no stance | May 14, 2026 | payer document |
| Aetna | Brexanolone (Zulresso) (0951) | listed, no stance (range 96365-96368) | Feb 13, 2026 | payer document |
| Aetna | Caplacizumab-yhdp (Cablivi) (0949) | listed, no stance (range 96365-96368) | Dec 3, 2025 | payer document |
| Aetna | Carfilzomib (Kyprolis) (0845) | listed, no stance (range 96365-96368) | Mar 2, 2026 | payer document |
| Aetna | Chelation Therapy (0234) | listed, no stance (range 96365-96368) | Feb 11, 2026 | payer document |
| Aetna | Clotting Factors (0131) | listed, no stance (range 96365-96379) | Apr 23, 2026 | payer document |
| Aetna | Complex Regional Pain Syndrome (CRPS): Treatments (0447) | listed, no stance (range 96365-96368) | Jul 16, 2026 | payer document |
| Aetna | Coronary Artery Brachytherapy and Other Adjuncts to Coronary Interventions (0491) | listed, no stance (range 96365-96368) | Jul 30, 2026 | payer document |
| Aetna | Crizanlizumab-tmca (Adakveo) (0964) | listed, no stance | Dec 9, 2025 | payer document |
| Aetna | Decitabine (0868) | listed, no stance (range 96360-96368) | Jun 10, 2026 | payer document |
| Aetna | Denileukin Diftitox-cxdl (Lymphir) (1070) | listed, no stance (range 96365-96368) | Apr 9, 2026 | payer document |
| Aetna | Diabetic Neuropathy: Selected Treatments (0729) | listed, no stance | Feb 24, 2026 | payer document |
| Aetna | Dinutuximab (Unituxin) (0895) | listed, no stance | Oct 23, 2025 | payer document |
| Aetna | Donanemab-azbt (Kisunla) (1066) | listed, no stance (range 96365-96368) | Oct 17, 2025 | payer document |
| Aetna | Edaravone Injection (0918) | listed, no stance | Jul 2, 2026 | payer document |
| Aetna | Efgartigimod Alfa-fcab (Vyvgart) and Efgartigimod Alfa and Hyaluronidase-qvfc (Vyvgart Hytrulo) (1002) | listed, no stance (range 96365-96368) | Aug 11, 2026 | payer document |
| Aetna | Elivaldogene Autotemcel (Skysona) (1017) | listed, no stance (range 96365-96368) | Apr 8, 2026 | payer document |
| Aetna | Emapalumab-lzsg (Gamifant) (0948) | listed, no stance | Dec 8, 2025 | payer document |
| Aetna | Eptinezumab-jjmr (Vyepti) (0970) | listed, no stance | Dec 9, 2025 | payer document |
| Aetna | Etranacogene Dezaparvovec-drlb (Hemgenix) (1023) | listed, no stance (range 96365-96368) | Apr 17, 2026 | payer document |
| Aetna | Etuvetidigene Autotemcel (Waskyra) (1097) | listed, no stance (range 96365-96368) | Oct 5, 2026 | payer document |
| Aetna | Evinacumab-dgnb (Evkeeza) (0989) | listed, no stance (range 96365-96368) | Apr 10, 2026 | payer document |
| Aetna | Exagamglogene Autotemcel (Casgevy) (1052) | listed, no stance (range 96365-96368) | Dec 31, 2025 | payer document |
| Aetna | Fidanacogene Elaparvovec-dzkt (Beqvez) (1060) | listed, no stance (range 96365-96368) | Apr 20, 2026 | payer document |
| Aetna | Gene-Based Therapy for Duchenne Muscular Dystrophy (DMD) (0911) | listed, no stance (range 96365-96368) | Aug 5, 2026 | payer document |
| Aetna | Golimumab (Simponi and Simponi Aria) (0790) | listed, no stance (range 96365-96368) | Jul 31, 2026 | payer document |
| Aetna | Gout (0810) | listed, no stance | Mar 27, 2026 | payer document |
| Aetna | Headaches: Nonsurgical Management (0462) | listed, no stance | Jul 23, 2026 | payer document |
| Aetna | Hematopoietic Colony-Stimulating Factors (CSFs) (0055) | listed, no stance (range 96365-96368) | Jul 16, 2026 | payer document |
| Aetna | Hereditary Angioedema (0782) | listed, no stance (range 96365-96368) | Sep 10, 2026 | payer document |
| Aetna | Histamine Desensitization Therapy for Intractable Headaches (0647) | listed, no stance (range 96365-96379) | Sep 14, 2026 | payer document |
| Aetna | Human Fibrinogen Concentrate Products (0792) | listed, no stance | Oct 5, 2026 | payer document |
| Aetna | Ibalizumab-uiyk (Trogarzo) (0936) | listed, no stance (range 96365-96368) | Dec 30, 2025 | payer document |
| Aetna | Immune Globulins for Post-Exposure Prophylaxis (0544) | listed, no stance | Oct 7, 2026 | payer document |
| Aetna | Inebilizumab-cdon (Uplizna) (0975) | listed, no stance (range 96365-96368) | Aug 11, 2026 | payer document |
| Aetna | Infliximab (0341) | listed, no stance (range 96365-96368) | Oct 5, 2026 | payer document |
| Aetna | Infusion Pumps (0161) | covered if criteria are met (range 96365-96368) | Mar 31, 2026 | payer document |
| Aetna | Injectable Medications (0020) | listed, no stance (range 96365-96379) | Mar 5, 2026 | payer document |
| Aetna | Inotuzumab Ozogamicin (Besponsa) (0919) | listed, no stance | Jan 27, 2026 | payer document |
| Aetna | Intravenous Iron Therapy (0575) | listed, no stance (range 96365-96368) | Jul 1, 2026 | payer document |
| Aetna | Ketamine for the Treatment of Depression and Other Selected Indications (0938) | listed, no stance (range 96365-96368) | Dec 30, 2025 | payer document |
| Aetna | Kidney Transplantation (0493) | listed, no stance | Jul 30, 2026 | payer document |
| Aetna | Lecanemab-irmb (Leqembi) (1026) | listed, no stance (range 96365-96368) | Jan 27, 2026 | payer document |
| Aetna | Levoleucovorin (Khapzory) (0889) | listed, no stance (range 96365-96368) | Dec 4, 2025 | payer document |
| Aetna | Lovotibeglogene Autotemcel (Lyfgenia) (1053) | listed, no stance (range 96365-96368) | Dec 31, 2025 | payer document |
| Aetna | Lurbinectedin (Zepzelca) (0978) | listed, no stance | Mar 11, 2026 | payer document |
| Aetna | Lyme Disease and other Tick-Borne Diseases (0215) | covered if criteria are met | Jul 21, 2026 | payer document |
| Aetna | Lysosomal Storage Disorder Treatments (0442) | listed, no stance (range 96365-96368) | Jul 8, 2026 | payer document |
| Aetna | Mirikizumab-mrkz (Omvoh) (1048) | listed, no stance (range 96365-96368) | Jul 1, 2026 | payer document |
| Aetna | Mirvetuximab Soravtansine-gynx (Elahere) (1021) | listed, no stance (range 96365-96368) | Jan 27, 2026 | payer document |
| Aetna | Multiple Sclerosis (0264) | listed, no stance (range 96365-96368) | Sep 10, 2026 | payer document |
| Aetna | Myalgic Encephalomyelitis - Chronic Fatigue Syndrome (ME/CSF) (0369) | listed, no stance | May 20, 2026 | payer document |
| Aetna | Narsoplimab-wuug (Yartemlea) (1099) | listed, no stance (range 96365-96368) | Apr 27, 2026 | payer document |
| Aetna | Natalizumab (0751) | listed, no stance (range 96365-96368) | Dec 2, 2025 | payer document |
| Aetna | Neonatal Hyperbilirubinemia (0332) | listed, no stance (range 96365-96368) | Jun 2, 2026 | payer document |
| Aetna | Nesiritide (Natrecor) (0709) | listed, no stance | Nov 24, 2025 | payer document |
| Aetna | Nivolumab Products (Opdivo, Opdivo Qvantig, and Opdualag) (0892) | listed, no stance (range 96365-96368) | Jul 16, 2026 | payer document |
| Aetna | Nusinersen (Spinraza) (0915) | listed, no stance (range 96365-96368) | Sep 9, 2026 | payer document |
| Aetna | Ofatumumab (Arzerra) (0794) | listed, no stance | Oct 24, 2025 | payer document |
| Aetna | Omidubicel-onlv (Omisirge) (1032) | listed, no stance | Apr 27, 2026 | payer document |
| Aetna | Onasemnogene Abeparvovec (Zolgensma and Itvisma) (0953) | listed, no stance (range 96365-96368) | Aug 10, 2026 | payer document |
| Aetna | Paclitaxel, Albumin-Bound (0834) | listed, no stance | May 28, 2026 | payer document |
| Aetna | Panitumumab (Vectibix) (0748) | listed, no stance (range 96365-96368) | Dec 23, 2025 | payer document |
| Aetna | Parenteral Immunoglobulins (0206) | listed, no stance | Oct 8, 2026 | payer document |
| Aetna | Pegzilarginase-nbln (Loargys) (1101) | listed, no stance (range 96365-96368) | Jun 26, 2026 | payer document |
| Aetna | Pemetrexed Products (0687) | listed, no stance | Jul 17, 2026 | payer document |
| Aetna | Plasminogen, Human-tvmh (Ryplazim) (0976) | listed, no stance (range 96365-96368) | Feb 17, 2026 | payer document |
| Aetna | Post-Herpetic Neuralgia (0725) | listed, no stance (range 96365-96379) | Oct 20, 2025 | payer document |
| Aetna | Pozelimab-bbfg (Veopoz) (1043) | listed, no stance | Dec 9, 2025 | payer document |
| Aetna | Pulmonary Hypertension Treatments and Selected Indications of Prostanoids (0184) | listed, no stance (range 96365-96371) | Sep 2, 2026 | payer document |
| Aetna | Ravulizumab-cwvz (Ultomiris) (0946) | listed, no stance | Aug 11, 2026 | payer document |
| Aetna | Remdesivir (Veklury) (0982) | listed, no stance (range 96365-96368) | Jan 13, 2026 | payer document |
| Aetna | Remestemcel-L-rknd (Ryoncil) (1077) | listed, no stance | May 27, 2026 | payer document |
| Aetna | Reslizumab (Cinqair) (0907) | listed, no stance (range 96365-96366) | Aug 10, 2026 | payer document |
| Aetna | Risankizumab-rzaa (Skyrizi) (1009) | listed, no stance (range 96365-96368) | Jul 1, 2026 | payer document |
| Aetna | Secukinumab (Cosentyx) (0905) | listed, no stance (range 96365-96368) | Aug 11, 2026 | payer document |
| Aetna | Siltuximab (Sylvant) (0884) | listed, no stance | Jun 3, 2026 | payer document |
| Aetna | Sirolimus Protein-Bound Particles for Injectable Suspension Albumin-Bound (Fyarro) (1001) | listed, no stance (range 96365-96368) | Mar 25, 2026 | payer document |
| Aetna | Sodium Thiosulfate (Pedmark) (1020) | listed, no stance | Aug 7, 2026 | payer document |
| Aetna | Somatostatin Analogs (0693) | listed, no stance (range 96361-96379) | Jul 15, 2026 | payer document |
| Aetna | Spesolimab-sbzo (Spevigo) (1013) | listed, no stance (range 96365-96368) | Apr 2, 2026 | payer document |
| Aetna | Sutimlimab-jome (Enjaymo) (1006) | listed, no stance (range 96365-96368) | Dec 3, 2025 | payer document |
| Aetna | Tebentafusp-tebn (Kimmtrak) (1005) | listed, no stance (range 96365-96368) | Apr 9, 2026 | payer document |
| Aetna | Teclistamab-cqyv (Tecvayli) (1018) | listed, no stance (range 96365-96368) | Jun 8, 2026 | payer document |
| Aetna | Teplizumab-mzwv (Tzield) (1022) | listed, no stance | Dec 3, 2025 | payer document |
| Aetna | Tisagenlecleucel (Kymriah) (0920) | listed, no stance (range 96365-96368) | Sep 11, 2026 | payer document |
| Aetna | Tocilizumab (0799) | listed, no stance | Jun 30, 2026 | 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.