96366 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 96366

Payer coverage policies that name 96366

96366 appears in 115 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.

PayerPolicyRole in policyReviewedDocument
AetnaAbatacept (Orencia) (0720)listed, no stance (range 96365-96368)Jul 1, 2026payer document
AetnaAdo-trastuzumab Emtansine (Kadcyla) (0974)listed, no stanceJan 21, 2026payer document
AetnaAducanumab-avwa (Aduhelm) (0996)listed, no stance (range 96365-96368)Dec 9, 2025payer document
AetnaAldesleukin (Proleukin) (0024)listed, no stance (range 96365-96368)Oct 9, 2026payer document
AetnaAlopecia Areata (0423)listed, no stance (range 96365-96367)Jul 10, 2026payer document
AetnaAnifrolumab-fnia (Saphnelo) (0997)listed, no stance (range 96365-96368)Jun 5, 2026payer document
AetnaAtidarsagene Autotemcel (Lenmeldy) (1058)listed, no stanceJul 13, 2026payer document
AetnaAttention Deficit/Hyperactivity Disorder (0426)listed, no stance (range 96365-96368)Jul 7, 2026payer document
AetnaBack Pain - Invasive Procedures (0016)listed, no stance (range 96365-96366)Oct 6, 2026payer document
AetnaBack Pain - Invasive Procedures (0016)listed, no stance (range 96365-96368)Oct 6, 2026payer document
AetnaBetibeglogene Autotemcel (Zynteglo) (1016)listed, no stance (range 96365-96368)Dec 31, 2025payer document
AetnaBezlotoxumab (Zinplava) (0914)listed, no stance (range 96365-96366)Jan 7, 2026payer document
AetnaBreast Biopsy Procedures (0269)listed, no stanceMay 14, 2026payer document
AetnaBrexanolone (Zulresso) (0951)listed, no stance (range 96365-96368)Feb 13, 2026payer document
AetnaCaplacizumab-yhdp (Cablivi) (0949)listed, no stance (range 96365-96368)Dec 3, 2025payer document
AetnaCarfilzomib (Kyprolis) (0845)listed, no stance (range 96365-96368)Mar 2, 2026payer document
AetnaChelation Therapy (0234)listed, no stance (range 96365-96368)Feb 11, 2026payer document
AetnaClotting Factors (0131)listed, no stance (range 96365-96379)Apr 23, 2026payer document
AetnaComplex Regional Pain Syndrome (CRPS): Treatments (0447)listed, no stance (range 96365-96368)Jul 16, 2026payer document
AetnaCoronary Artery Brachytherapy and Other Adjuncts to Coronary Interventions (0491)listed, no stance (range 96365-96368)Jul 30, 2026payer document
AetnaDecitabine (0868)listed, no stance (range 96360-96368)Jun 10, 2026payer document
AetnaDenileukin Diftitox-cxdl (Lymphir) (1070)listed, no stance (range 96365-96368)Apr 9, 2026payer document
AetnaDiabetic Neuropathy: Selected Treatments (0729)listed, no stanceFeb 24, 2026payer document
AetnaDinutuximab (Unituxin) (0895)listed, no stanceOct 23, 2025payer document
AetnaDonanemab-azbt (Kisunla) (1066)listed, no stance (range 96365-96368)Oct 17, 2025payer document
AetnaEfgartigimod Alfa-fcab (Vyvgart) and Efgartigimod Alfa and Hyaluronidase-qvfc (Vyvgart Hytrulo) (1002)listed, no stance (range 96365-96368)Aug 11, 2026payer document
AetnaElivaldogene Autotemcel (Skysona) (1017)listed, no stance (range 96365-96368)Apr 8, 2026payer document
AetnaEmapalumab-lzsg (Gamifant) (0948)listed, no stanceDec 8, 2025payer document
AetnaEptinezumab-jjmr (Vyepti) (0970)listed, no stanceDec 9, 2025payer document
AetnaEtranacogene Dezaparvovec-drlb (Hemgenix) (1023)listed, no stance (range 96365-96368)Apr 17, 2026payer document
AetnaEtuvetidigene Autotemcel (Waskyra) (1097)listed, no stance (range 96365-96368)Oct 5, 2026payer document
AetnaEvinacumab-dgnb (Evkeeza) (0989)listed, no stance (range 96365-96368)Apr 10, 2026payer document
AetnaExagamglogene Autotemcel (Casgevy) (1052)listed, no stance (range 96365-96368)Dec 31, 2025payer document
AetnaFidanacogene Elaparvovec-dzkt (Beqvez) (1060)listed, no stance (range 96365-96368)Apr 20, 2026payer document
AetnaGene-Based Therapy for Duchenne Muscular Dystrophy (DMD) (0911)listed, no stance (range 96365-96368)Aug 5, 2026payer document
AetnaGolimumab (Simponi and Simponi Aria) (0790)listed, no stance (range 96365-96368)Jul 31, 2026payer document
AetnaGout (0810)listed, no stanceMar 27, 2026payer document
AetnaHematopoietic Colony-Stimulating Factors (CSFs) (0055)listed, no stance (range 96365-96368)Jul 16, 2026payer document
AetnaHereditary Angioedema (0782)listed, no stance (range 96365-96368)Sep 10, 2026payer document
AetnaHistamine Desensitization Therapy for Intractable Headaches (0647)listed, no stance (range 96365-96379)Sep 14, 2026payer document
AetnaHuman Fibrinogen Concentrate Products (0792)listed, no stanceOct 5, 2026payer document
AetnaIbalizumab-uiyk (Trogarzo) (0936)listed, no stance (range 96365-96368)Dec 30, 2025payer document
AetnaImmune Globulins for Post-Exposure Prophylaxis (0544)listed, no stanceOct 7, 2026payer document
AetnaInebilizumab-cdon (Uplizna) (0975)listed, no stance (range 96365-96368)Aug 11, 2026payer document
AetnaInfliximab (0341)listed, no stance (range 96365-96368)Oct 5, 2026payer document
AetnaInfusion Pumps (0161)covered if criteria are met (range 96365-96368)Mar 31, 2026payer document
AetnaInjectable Medications (0020)listed, no stance (range 96365-96379)Mar 5, 2026payer document
AetnaInotuzumab Ozogamicin (Besponsa) (0919)listed, no stanceJan 27, 2026payer document
AetnaIntravenous Iron Therapy (0575)listed, no stance (range 96365-96368)Jul 1, 2026payer document
AetnaKetamine for the Treatment of Depression and Other Selected Indications (0938)listed, no stance (range 96365-96368)Dec 30, 2025payer document
AetnaKidney Transplantation (0493)listed, no stanceJul 30, 2026payer document
AetnaLecanemab-irmb (Leqembi) (1026)listed, no stance (range 96365-96368)Jan 27, 2026payer document
AetnaLevoleucovorin (Khapzory) (0889)listed, no stance (range 96365-96368)Dec 4, 2025payer document
AetnaLovotibeglogene Autotemcel (Lyfgenia) (1053)listed, no stance (range 96365-96368)Dec 31, 2025payer document
AetnaLurbinectedin (Zepzelca) (0978)listed, no stanceMar 11, 2026payer document
AetnaLyme Disease and other Tick-Borne Diseases (0215)covered if criteria are metJul 21, 2026payer document
AetnaLysosomal Storage Disorder Treatments (0442)listed, no stance (range 96365-96368)Jul 8, 2026payer document
AetnaMirikizumab-mrkz (Omvoh) (1048)listed, no stance (range 96365-96368)Jul 1, 2026payer document
AetnaMirvetuximab Soravtansine-gynx (Elahere) (1021)listed, no stance (range 96365-96368)Jan 27, 2026payer document
AetnaMultiple Sclerosis (0264)listed, no stance (range 96365-96368)Sep 10, 2026payer document
AetnaMyalgic Encephalomyelitis - Chronic Fatigue Syndrome (ME/CSF) (0369)listed, no stanceMay 20, 2026payer document
AetnaNarsoplimab-wuug (Yartemlea) (1099)listed, no stance (range 96365-96368)Apr 27, 2026payer document
AetnaNatalizumab (0751)listed, no stance (range 96365-96368)Dec 2, 2025payer document
AetnaNeonatal Hyperbilirubinemia (0332)listed, no stance (range 96365-96368)Jun 2, 2026payer document
AetnaNesiritide (Natrecor) (0709)listed, no stanceNov 24, 2025payer document
AetnaNivolumab Products (Opdivo, Opdivo Qvantig, and Opdualag) (0892)listed, no stance (range 96365-96368)Jul 16, 2026payer document
AetnaNusinersen (Spinraza) (0915)listed, no stance (range 96365-96368)Sep 9, 2026payer document
AetnaOmidubicel-onlv (Omisirge) (1032)listed, no stanceApr 27, 2026payer document
AetnaOnasemnogene Abeparvovec (Zolgensma and Itvisma) (0953)listed, no stance (range 96365-96368)Aug 10, 2026payer document
AetnaPaclitaxel, Albumin-Bound (0834)listed, no stanceMay 28, 2026payer document
AetnaPanitumumab (Vectibix) (0748)listed, no stance (range 96365-96368)Dec 23, 2025payer document
AetnaParenteral Immunoglobulins (0206)listed, no stanceOct 8, 2026payer document
AetnaPegzilarginase-nbln (Loargys) (1101)listed, no stance (range 96365-96368)Jun 26, 2026payer document
AetnaPemetrexed Products (0687)listed, no stanceJul 17, 2026payer document
AetnaPlasminogen, Human-tvmh (Ryplazim) (0976)listed, no stance (range 96365-96368)Feb 17, 2026payer document
AetnaPost-Herpetic Neuralgia (0725)listed, no stance (range 96365-96379)Oct 20, 2025payer document
AetnaPulmonary Hypertension Treatments and Selected Indications of Prostanoids (0184)listed, no stance (range 96365-96371)Sep 2, 2026payer document
AetnaRavulizumab-cwvz (Ultomiris) (0946)listed, no stanceAug 11, 2026payer document
AetnaRemdesivir (Veklury) (0982)listed, no stance (range 96365-96368)Jan 13, 2026payer document
AetnaRemestemcel-L-rknd (Ryoncil) (1077)listed, no stanceMay 27, 2026payer document
AetnaReslizumab (Cinqair) (0907)listed, no stance (range 96365-96366)Aug 10, 2026payer document
AetnaRisankizumab-rzaa (Skyrizi) (1009)listed, no stance (range 96365-96368)Jul 1, 2026payer document
AetnaSecukinumab (Cosentyx) (0905)listed, no stance (range 96365-96368)Aug 11, 2026payer document
AetnaSirolimus Protein-Bound Particles for Injectable Suspension Albumin-Bound (Fyarro) (1001)listed, no stance (range 96365-96368)Mar 25, 2026payer document
AetnaSomatostatin Analogs (0693)listed, no stance (range 96361-96379)Jul 15, 2026payer document
AetnaSpesolimab-sbzo (Spevigo) (1013)listed, no stance (range 96365-96368)Apr 2, 2026payer document
AetnaSutimlimab-jome (Enjaymo) (1006)listed, no stance (range 96365-96368)Dec 3, 2025payer document
AetnaTebentafusp-tebn (Kimmtrak) (1005)listed, no stance (range 96365-96368)Apr 9, 2026payer document
AetnaTeclistamab-cqyv (Tecvayli) (1018)listed, no stance (range 96365-96368)Jun 8, 2026payer document
AetnaTisagenlecleucel (Kymriah) (0920)listed, no stance (range 96365-96368)Sep 11, 2026payer document
AetnaTocilizumab (0799)listed, no stanceJun 30, 2026payer document
AetnaTransthyretin-Mediated (ATTR) Amyloidosis (0939)listed, no stance (range 96365-96368)Aug 10, 2026payer document
AetnaTrastuzumab Products (0313)listed, no stanceJun 8, 2026payer document
AetnaTremelimumab-actl (Imjudo) (1019)listed, no stance (range 96365-96368)Apr 27, 2026payer document
AetnaTrigeminal Neuralgia: Treatments (0374)listed, no stance (range 96365-96368)Jun 29, 2026payer document
AetnaUstekinumab (0912)listed, no stance (range 96365-96368)Jul 1, 2026payer document
AetnaValoctocogene Roxaparvovec-rvox (Roctavian) (1037)listed, no stance (range 96365-96368)Apr 20, 2026payer document
AetnaZoledronic Acid (0524)listed, no stance (range 96365-96368)Feb 12, 2026payer document
AnthemParenteral Antibiotics for the Treatment of Lyme Disease (CG-MED-98)covered if criteria are metNov 6, 2025payer document
Blue Cross & Blue Shield of MississippiIntravenous Anesthetics For The Treatment Of Chronic Pain And Psychiatric Disordersunproven / investigationalpayer document

Medicaid fee-for-service

  • AZ: $29.00 (outpatient_hospital), effective Oct 1, 2021
  • CO: $16.75 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $16.63 (physician, non-facility), effective Jan 1, 2026
  • IL: $18.89 (practitioner), effective Apr 1, 2024
  • IN: $15.48 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $11.30 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $45.00 (asc), effective Jan 1, 2026
  • MA: $15.86 (physician_medicine), effective May 1, 2024
  • MS: $35.56 (comprehensive), effective Jul 1, 2026
  • ND: $23.66 (physician), effective Aug 1, 2026
  • NE: $18.63 (physician, non-facility), effective Jul 1, 2026
  • NY: $10.99 (nurse_practitioner, facility), effective Jul 1, 2026
  • OH: $16.78 (physician), effective Jan 1, 2024
  • OK: $42.17 (outpatient_hospital_apc), effective Jan 1, 2026
  • TX: $14.76 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Mar 1, 2026
  • VA: $18.52 (medical), effective Jul 1, 2026
  • VT: $36.36 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $13.19 (physician, facility), effective Jul 1, 2026
  • WY: $20.71 (outpatient_hospital_apc, Ambulatory Surgical Centers), effective Apr 1, 2026

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.