97162 CPT® code: payer coverage and prior authorization6 of 9 payer prior-auth lists that name 97162 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Humana, Molina Healthcare of Texas, UnitedHealthcare Community Plan.
97162 appears in 43 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Blue Shield of California, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, 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 (range 97161-97164) | Jul 7, 2026 | payer document |
| Aetna | Autism Spectrum Disorders (0648) | covered if criteria are met (range 97161-97168) | Oct 2, 2025 | 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 97161-97168) | Oct 6, 2026 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 97010-97799) | Oct 6, 2026 | payer document |
| Aetna | Burn Garments (0062) | listed, no stance (range 97110-97546) | Jan 15, 2026 | payer document |
| Aetna | Burn Garments (0062) | listed, no stance (range 97161-97168) | 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 | Early Intervention Programs (0444) | listed, no stance (range 97110-97546) | Jul 1, 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 | Hip Arthroplasty (0287) | listed, no stance (range 97010-97546) | Sep 23, 2026 | payer document |
| Aetna | Hip Preservation Surgery (0736) | listed, no stance (range 97161-97164) | Jul 31, 2026 | payer document |
| Aetna | Home Health Aides (0218) | listed, no stance (range 97010-97799) | Sep 10, 2026 | payer document |
| Aetna | Intervertebral Disc Prostheses (0591) | listed, no stance (range 97110-97546) | Sep 18, 2026 | payer document |
| Aetna | Knee Arthroplasty (0660) | listed, no stance (range 97010-97799) | Oct 8, 2026 | payer document |
| Aetna | Pediatric Intensive Feeding Programs (0809) | listed, no stance (range 97161-97168) | Dec 11, 2025 | payer document |
| Aetna | Physical Therapy (0325) | covered if criteria are met (range 97161-97164) | Jun 2, 2026 | payer document |
| Aetna | Spinal Surgery: Laminectomy and Fusion (0743) | listed, no stance (range 97110-97546) | Jul 30, 2026 | payer document |
| Aetna | Standing Frames, Tables, and Transfer Boards (0481) | listed, no stance (range 97001-97763) | Jul 2, 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 |
| Blue Cross & Blue Shield of Rhode Island | Autism Spectrum Disorders Mandate | covered if criteria are met | Apr 15, 2026 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Physical and Occupational Services | covered if criteria are met | Feb 17, 2026 | 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 | |
| Centene | Skilled Nursing Facility Leveling (CP.MP.206) | covered if criteria are met | Aug 1, 2022 | payer document |
| Cigna | Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment (0447) | covered if criteria are met | May 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 |
| Premera Blue Cross | Preventive Care Covered with written prescription | The USPSTF recommends | covered if criteria are met | Sep 21, 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 | Home Health, Skilled, and Custodial Care Services (for North Carolina Only) (CSNC.MP.022.08) | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in LA, ND, VA, 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.