96367 CPT® code: payer coverage and prior authorization96367 appears in 87 coverage policies from Aetna, Anthem, BlueCross BlueShield of South Carolina, Centene.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Abatacept (Orencia) (0720) | listed, no stance (range 96365-96368) | Jul 1, 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 | 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 | Betibeglogene Autotemcel (Zynteglo) (1016) | listed, no stance (range 96365-96368) | Dec 31, 2025 | 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 | 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 | Donanemab-azbt (Kisunla) (1066) | listed, no stance (range 96365-96368) | Oct 17, 2025 | 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 | 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 | 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 | 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 | 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 | 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 | 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 | Pulmonary Hypertension Treatments and Selected Indications of Prostanoids (0184) | listed, no stance (range 96365-96371) | Sep 2, 2026 | payer document |
| Aetna | Remdesivir (Veklury) (0982) | listed, no stance (range 96365-96368) | Jan 13, 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 | Sirolimus Protein-Bound Particles for Injectable Suspension Albumin-Bound (Fyarro) (1001) | listed, no stance (range 96365-96368) | Mar 25, 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 | 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 |
| Aetna | Transthyretin-Mediated (ATTR) Amyloidosis (0939) | listed, no stance (range 96365-96368) | Aug 10, 2026 | payer document |
| Aetna | Tremelimumab-actl (Imjudo) (1019) | listed, no stance (range 96365-96368) | Apr 27, 2026 | payer document |
| Aetna | Trigeminal Neuralgia: Treatments (0374) | listed, no stance (range 96365-96368) | Jun 29, 2026 | payer document |
| Aetna | Ustekinumab (0912) | listed, no stance (range 96365-96368) | Jul 1, 2026 | payer document |
| Aetna | Valoctocogene Roxaparvovec-rvox (Roctavian) (1037) | listed, no stance (range 96365-96368) | Apr 20, 2026 | payer document |
| Aetna | Zoledronic Acid (0524) | listed, no stance (range 96365-96368) | Feb 12, 2026 | payer document |
| Anthem | Parenteral Antibiotics for the Treatment of Lyme Disease (CG-MED-98) | covered if criteria are met | Nov 6, 2025 | payer document |
| BlueCross BlueShield of South Carolina | Abatacept (Orencia®) (CAM 069) | listed, no stance (range 96365-96368) | Apr 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Hereditary Angioedema Drug Therapy (CAM 066) | listed, no stance (range 96365-96368) | Jan 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Natalizumab (Tysabri®) (CAM 059) | listed, no stance (range 96365-96368) | Nov 1, 2025 | payer document |
| Centene | Attention Deficit Hyperactivity Disorder Assessment and Treatment (CP.BH.124) | not covered | Mar 1, 2024 | payer document |
| Centene | Attention Deficit Hyperactivity Disorder Assessment and Treatment (CP.MP.124) | not covered | Feb 1, 2022 | 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.