97026 CPT® code: payer coverage and prior authorization47 of 47 payer prior-auth lists that name 97026 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Blue Shield of California, CarePlus Health Plans, Humana, Molina Healthcare of Texas, UnitedHealthcare, UnitedHealthcare Community Plan.
97026 appears in 50 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Attention Deficit/Hyperactivity Disorder (0426) EEG theta/beta power ratio, Gut microbiota profile, polygenic risk score, evaluation of kynurenine pathway | not covered | Jul 7, 2026 | payer document |
| Aetna | Autism Spectrum Disorders (0648) | listed, no stance (range 97010-97546) | Oct 2, 2025 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 97010-97763) | Oct 6, 2026 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 97010-97139) | Oct 6, 2026 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 97010-97799) | Oct 6, 2026 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 97010-97039) | Oct 6, 2026 | payer document |
| Aetna | Burn Garments (0062) | listed, no stance (range 97010-97028) | Jan 15, 2026 | payer document |
| Aetna | Chiropractic Services (0107) | listed, no stance (range 97010-97799) | Apr 7, 2026 | payer document |
| Aetna | Chronic Pain Rehabilitation Programs (0237) | listed, no stance (range 97010-97546) | Apr 23, 2026 | payer document |
| Aetna | Complex Regional Pain Syndrome (CRPS): Treatments (0447) | listed, no stance (range 97010-97168) | Jul 16, 2026 | payer document |
| Aetna | Diabetic Neuropathy: Selected Treatments (0729) | not covered | Feb 24, 2026 | payer document |
| Aetna | Eagle's and Ernest Syndrome (0400) | listed, no stance (range 97010-97028) | Jun 30, 2026 | payer document |
| Aetna | Electrodiagnostic Testing (0502) | listed, no stance (range 97010-97799) | Jul 29, 2026 | payer document |
| Aetna | Functional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677) | listed, no stance (range 97010-97763) | Sep 10, 2026 | payer document |
| Aetna | Heating Devices (0540) | listed, no stance | Jul 31, 2026 | payer document |
| Aetna | Hip Arthroplasty (0287) | listed, no stance (range 97010-97546) | Sep 23, 2026 | payer document |
| Aetna | Home Health Aides (0218) | listed, no stance (range 97010-97799) | Sep 10, 2026 | payer document |
| Aetna | Infrared Therapy (0604) | not covered | Sep 9, 2026 | payer document |
| Aetna | Intervertebral Disc Prostheses (0591) | listed, no stance (range 97010-97039) | Sep 18, 2026 | payer document |
| Aetna | Knee Arthroplasty (0660) | listed, no stance (range 97010-97799) | Oct 8, 2026 | payer document |
| Aetna | Physical Therapy (0325) | covered if criteria are met | Jun 2, 2026 | payer document |
| Aetna | Standing Frames, Tables, and Transfer Boards (0481) | listed, no stance (range 97001-97763) | Jul 2, 2026 | payer document |
| Aetna | Temporomandibular Disorders (0028) | not covered | Mar 12, 2026 | payer document |
| Aetna | Total Ankle Arthroplasty (0645) | listed, no stance (range 97001-97799) | Sep 14, 2026 | payer document |
| Aetna | Transforaminal Epidural Injections (0722) | listed, no stance (range 97010-97530) | Oct 20, 2025 | payer document |
| Aetna | Vasectomy Procedures and Chronic Scrotal Content Pain (0027) | listed, no stance (range 97010-97799) | Jan 27, 2026 | payer document |
| Aetna | Vulvodynia and Vulvar Vestibulitis Treatments (0759) | covered if criteria are met (range 97010-97032) | Nov 12, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | Lowlevel Laser Therapy | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Mississippi | Temporomandibular Joint Disorder | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Autism Spectrum Disorders Mandate PAYMENT POLICY | 5 | covered if criteria are met | Apr 15, 2026 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Physical and Occupational Services PAYMENT POLICY | 3 | covered if criteria are met | Feb 17, 2026 | payer document |
| Blue Cross NC | Chiropractic Services | listed, no stance | Sep 1, 2025 | payer document |
| Blue Cross NC | Rehabilitative Therapies | listed, no stance | Sep 1, 2025 | payer document |
| Blue Shield of California | BSC8.03 | Physical Therapy | listed, no stance | payer document | |
| Blue Shield of California | | Temporomandibular Joint Disorder (2.01.21) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Temporomandibular Joint Dysfunction (CAM 20121) | listed, no stance | Aug 1, 2026 | payer document |
| Centene | Attention Deficit Hyperactivity Disorder Assessment and Treatment (CP.BH.124) | not covered | Mar 1, 2024 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Infrared Therapy Devices (DME101.045) | listed, no stance | Apr 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Physical Therapy (PT) and Occupational Therapy (OT) Services (THE803.010) CPT Codes 95851, 95852, 95992, 96125, 97010, 97012, 97014, 97016, 97018, | listed, no stance | Jan 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Temporomandibular Joint Disorders (SUR705.010) CPT Codes 20550, 20605, 20606, 21010, 21050, 21060, 21070, 21073, 21076, | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (CS164.M) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (MP.026.27) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Florida Only) (CS164FL.N) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Idaho Only) (CS164ID.C) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Kentucky Only) (CS164KY.10) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Nebraska Only) (CS164NE.K) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for New Jersey Only) (CS164NJ.H) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for New Mexico Only) (CS164NM.C) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for North Carolina Only) (CSNC.MP.164.05) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Ohio Only) (CS164OH.D) | listed, no stance | Nov 1, 2025 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) (for Pennsylvania Only) (CS164PA.E) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Habilitation and Rehabilitation Therapy (Occupational, Physical, and Speech) – Site of Service (for Florida Only) (CS161FL.M) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Skilled Nursing Facility, Rehabilitation, Long-Term Acute Care Hospital, and Private Duty Nursing (MMP079.19) | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in CO, IN, MS, WV.
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.