96401 CPT® code: payer coverage and prior authorization96401 appears in 90 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, BlueCross BlueShield of South Carolina, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Adalimumab (0655) | listed, no stance (range 96401-96450) | Jul 13, 2026 | payer document |
| Aetna | Ado-trastuzumab Emtansine (Kadcyla) (0974) | listed, no stance (range 96401-96450) | Jan 21, 2026 | payer document |
| Aetna | Aldesleukin (Proleukin) (0024) | not covered (range 96401-96402) | Oct 9, 2026 | payer document |
| Aetna | Antiemetic Therapy (0724) | listed, no stance (range 96401-96549) | Jul 17, 2026 | payer document |
| Aetna | Asparaginase Erwinia Chrysanthemi (Recombinant)-rywn (Rylaze) (0864) | listed, no stance | Dec 2, 2025 | payer document |
| Aetna | Atezolizumab (Tecentriq) and Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza) (0909) | listed, no stance | Sep 28, 2026 | payer document |
| Aetna | Azacitidine (0960) | listed, no stance | Jun 12, 2026 | payer document |
| Aetna | Bevacizumab for Non-Ocular Indications (0685) | listed, no stance (range 96401-96450) | Apr 7, 2026 | payer document |
| Aetna | Bortezomib Products (0675) | listed, no stance | Feb 17, 2026 | payer document |
| Aetna | Brentuximab Vedotin (Adcetris) (0823) | listed, no stance (range 96401-96450) | Sep 24, 2026 | payer document |
| Aetna | Caplacizumab-yhdp (Cablivi) (0949) | listed, no stance | Dec 3, 2025 | payer document |
| Aetna | Cemiplimab-rwlc (Libtayo) (0942) | listed, no stance (range 96401-96450) | Jun 12, 2026 | payer document |
| Aetna | Certolizumab Pegol (Cimzia) (0761) | listed, no stance | Jul 1, 2026 | payer document |
| Aetna | Cetuximab (Erbitux) (0684) | listed, no stance (range 96401-96450) | Dec 3, 2025 | payer document |
| Aetna | Crovalimab-akkz (PiaSky) (1064) | listed, no stance (range 96401-96402) | Mar 27, 2026 | payer document |
| Aetna | Denosumab (0804) | listed, no stance (range 96401-96450) | Aug 21, 2026 | payer document |
| Aetna | Depemokimab-ulaa (Exdensur) (1098) | listed, no stance | Aug 10, 2026 | payer document |
| Aetna | Dinutuximab (Unituxin) (0895) | listed, no stance (range 96401-96450) | Oct 23, 2025 | payer document |
| Aetna | Elranatamab-bcmm (Elrexfio) (1040) | listed, no stance | Dec 10, 2025 | payer document |
| Aetna | Epcoritamab-bysp (Epkinly) (1034) | listed, no stance | Jul 29, 2026 | payer document |
| Aetna | Erythropoiesis Stimulating Agents (0195) | listed, no stance (range 96401-96417) | Jan 20, 2026 | payer document |
| Aetna | Etanercept (0315) CD11c expression and DNA methylation as biomarkers of etanercept response | listed, no stance (range 96401-96450) | Jul 8, 2026 | payer document |
| Aetna | Fam-trastuzumab Deruxtecan-nxki (Enhertu) (0966) | listed, no stance (range 96401-96450) | Sep 17, 2026 | payer document |
| Aetna | Gonadotropin-Releasing Hormone Analogs and Antagonists (0501) | listed, no stance | Jul 10, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Hodgkin's Disease (0495) | listed, no stance (range 96401-96450) | Jul 2, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Multiple Myeloma (0497) | listed, no stance (range 96401-96450) | Aug 5, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Non-Hodgkin's Lymphoma (0494) | listed, no stance (range 96401-96450) | Aug 3, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Ovarian Cancer (0635) | listed, no stance (range 96401-96549) | Sep 11, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Selected Childhood Solid Tumors (0496) | listed, no stance (range 96401-96425) | Aug 6, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Selected Leukemias (0640) | listed, no stance (range 96401-96450) | Sep 11, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Testicular Cancer (0617) | covered if criteria are met (range 96401-96549) | Sep 3, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Thalassemia Major and Sickle Cell Anemia (0626) | listed, no stance (range 96401-96450) | Sep 18, 2026 | payer document |
| Aetna | Hematopoietic Colony-Stimulating Factors (CSFs) (0055) | listed, no stance (range 96401-96549) | Jul 16, 2026 | payer document |
| Aetna | Hereditary Angioedema (0782) | listed, no stance | Sep 10, 2026 | payer document |
| Aetna | Ibritumomab Tiuxetan (Zevalin) (0659) | listed, no stance (range 96401-96450) | Nov 26, 2025 | payer document |
| Aetna | Infertility (0327) | listed, no stance (range 96401-96548) | Jul 16, 2026 | payer document |
| Aetna | Infliximab (0341) | listed, no stance (range 96401-96450) | Oct 5, 2026 | payer document |
| Aetna | Inotuzumab Ozogamicin (Besponsa) (0919) | listed, no stance (range 96401-96450) | Jan 27, 2026 | payer document |
| Aetna | Irinotecan Liposome Injection (Onivyde) (0902) | listed, no stance (range 96401-96411) | Feb 24, 2026 | payer document |
| Aetna | Mepolizumab (Nucala) (0897) | listed, no stance | Aug 5, 2026 | payer document |
| Aetna | Mirikizumab-mrkz (Omvoh) (1048) | listed, no stance | Jul 1, 2026 | payer document |
| Aetna | Mosunetuzumab-axgb (Lunsumio and Lunsumio Velo) (1025) | listed, no stance | Apr 24, 2026 | payer document |
| Aetna | Motixafortide (Aphexda) (1046) | listed, no stance | Dec 11, 2025 | payer document |
| Aetna | Nivolumab Products (Opdivo, Opdivo Qvantig, and Opdualag) (0892) | listed, no stance | Jul 16, 2026 | payer document |
| Aetna | Omalizumab (0670) | listed, no stance (range 96401-96549) | Aug 21, 2026 | payer document |
| Aetna | Oxaliplatin (0683) | listed, no stance (range 96401-96450) | Dec 5, 2025 | payer document |
| Aetna | Pegaspargase (Oncaspar) (0959) | listed, no stance | Dec 3, 2025 | payer document |
| Aetna | Pembrolizumab Products (Keytruda and Keytruda Qlex) (0890) | listed, no stance (range 96401-96411) | Jul 14, 2026 | payer document |
| Aetna | Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo) (0977) | listed, no stance | Apr 24, 2026 | payer document |
| Aetna | Risankizumab-rzaa (Skyrizi) (1009) | listed, no stance | Jul 1, 2026 | payer document |
| Aetna | Rituximab (0314) | listed, no stance (range 96401-96446) | Sep 15, 2026 | payer document |
| Aetna | Rituximab (0314) | listed, no stance (range 96401-96402) | Sep 15, 2026 | payer document |
| Aetna | Romidepsin (0865) | listed, no stance (range 96401-96549) | Apr 17, 2026 | payer document |
| Aetna | Rozanolixizumab-noli (Rystiggo) (1035) | listed, no stance | Aug 11, 2026 | payer document |
| Aetna | Scalp Cooling (Hypothermia) to Prevent Hair Loss During Chemotherapy (0290) | listed, no stance (range 96401-96450) | Jun 8, 2026 | payer document |
| Aetna | Secukinumab (Cosentyx) (0905) | listed, no stance | Aug 11, 2026 | payer document |
| Aetna | Sipuleucel-T (Provenge) (0802) | listed, no stance (range 96401-96417) | Dec 22, 2025 | payer document |
| Aetna | Strontium Chloride Sr-89 (0361) | listed, no stance (range 96401-96450) | Jan 9, 2026 | payer document |
| Aetna | Tagraxofusp-erzs (Elzonris) (0947) | listed, no stance (range 96401-96450) | May 28, 2026 | payer document |
| Aetna | Talimogene Laherparepvec (Imlygic) (0900) | listed, no stance | Apr 14, 2026 | payer document |
| Aetna | Talquetamab-tgvs (Talvey) (1042) | listed, no stance | Oct 9, 2026 | payer document |
| Aetna | Tarlatamab-dlle (Imdelltra) (1062) | listed, no stance (range 96401-96548) | Aug 7, 2026 | payer document |
| Aetna | Teclistamab-cqyv (Tecvayli) (1018) | listed, no stance | Jun 8, 2026 | payer document |
| Aetna | Telisotuzumab Vedotin-tllv (Emrelis) (1085) | listed, no stance (range 96401-96548) | Aug 7, 2026 | payer document |
| Aetna | Tezepelumab-ekko (Tezspire) (1003) | listed, no stance | Aug 6, 2026 | payer document |
| Aetna | Tocilizumab (0799) | listed, no stance | Jun 30, 2026 | payer document |
| Aetna | Trastuzumab Products (0313) | listed, no stance (range 96401-96450) | Jun 8, 2026 | payer document |
| Aetna | Ustekinumab (0912) | listed, no stance | Jul 1, 2026 | payer document |
| Aetna | Voice Therapy (0646) | listed, no stance (range 96401-96417) | Sep 9, 2026 | payer document |
| Aetna | Ziv-Aflibercept (Zaltrap) (0842) | listed, no stance (range 96401-96450) | Dec 9, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | Allogeneic Hematopoietic Cell Transplantation For Genetic Diseases And Acquired Anemias (L.8.01.412) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Allogeneic Hematopoietic Cell Transplantation For Myelodysplastic Syndromes And Myeloproliferative Neoplasms | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Autologous Hematopoietic Stemcell Transplantation For Malignant Astrocytomas And Gliomas (L.8.01.405) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Acute Lymphoblastic Leukemia | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Acute Myeloid Leukemia | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Autoimmune Diseases | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Chronic Lymphocytic Leukemiasmall Lymphocytic Lymphoma | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Chronic Myeloid Leukemia | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Cns Embryonal Tumors And Ependymoma | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Epithelial Ovarian Cancer | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Hodgkin Lymphoma | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Miscellaneous Solid Tumors In Adults | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Nonhodgkin Lymphomas | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Plasma Cell Dyscrasias Including Multiple Myeloma And Poems Syndrome | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Primary Amyloidosis Or Waldenstroms Macroglobulinemia | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation For Solid Tumors Of Childhood | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Cell Transplantation In The Treatment Of Germ Cell Tumors | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hematopoietic Stemcell Transplantation For Breast Cancer (L.8.01.410) | not covered | payer document | |
| Blue Cross & Blue Shield of Mississippi | Nonmyeloablative Allogeneic Transplants Of Hematopoietic Stemcells For Treatment Of Malignancy (L.8.01.406) | covered if criteria are met | payer document | |
| BlueCross BlueShield of South Carolina | Emapalumab-lzsg (Gamifant) (CAM 224) | listed, no stance (range 96401-96450) | Jul 1, 2026 | payer document |
| UnitedHealthcare | Immunomodulators for Inflammatory Conditions (for Indiana Only) (CSIND0150.08) | listed, no stance | Jan 1, 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.