97605 CPT® code: payer coverage and prior authorization20 of 20 payer prior-auth lists that name 97605 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, CarePlus Health Plans, Humana, Rocky Mountain Health Plans.
97605 appears in 31 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | 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 97010-97799) | Oct 6, 2026 | payer document |
| Aetna | Chiropractic Services (0107) | listed, no stance (range 97010-97799) | Apr 7, 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 | Home Health Aides (0218) | listed, no stance (range 97010-97799) | Sep 10, 2026 | payer document |
| Aetna | Knee Arthroplasty (0660) | listed, no stance (range 97010-97799) | Oct 8, 2026 | payer document |
| Aetna | Negative Pressure Wound Therapy (0334) | covered if criteria are met | Jun 8, 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 | Vasectomy Procedures and Chronic Scrotal Content Pain (0027) | listed, no stance (range 97010-97799) | Jan 27, 2026 | payer document |
| Aetna | Wound Care: Home or Outpatient Setting (1054) | listed, no stance (range 97597-97610) | Dec 23, 2025 | payer document |
| Anthem | Vacuum Assisted Wound Therapy in the Outpatient Setting (CG-DME-48) | covered if criteria are met | Aug 13, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Negative Pressure Wound Therapy | covered if criteria are met | payer document | |
| Blue Cross Blue Shield of Massachusetts | Negative Pressure Wound Therapy in the Outpatient Setting (543) | listed, no stance | payer document | |
| Blue Cross NC | Topical Negative Pressure Therapy for Wounds | listed, no stance | Apr 1, 2026 | payer document |
| Blue Shield of California | Negative Pressure Wound Therapy in the Outpatient Setting (1.01.16) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Negative Pressure Wound Therapy in the Outpatient Setting (CAM 10116) | listed, no stance | Jun 1, 2026 | payer document |
| Capital Blue Cross | Negative Pressure Wound Therapy in the Outpatient Setting (MP 4.004) Procedure codes | covered if criteria are met | Jun 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Negative Pressure Wound Therapy in the Outpatient Setting (DME101.036) | listed, no stance | May 1, 2026 | payer document |
| Premera Blue Cross | Negative Pressure Wound Therapy (NPWT) Devices (1.01.508) | listed, no stance | May 12, 2026 | payer document |
| UnitedHealthcare | Negative Pressure Wound Therapy (2026T0594O) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Negative Pressure Wound Therapy (CS157.M) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Negative Pressure Wound Therapy (for Idaho Only) (CS157ID.D) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Negative Pressure Wound Therapy (for Kansas Only) (CS157KS.02) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Negative Pressure Wound Therapy (for Kentucky Only) (CS157KY.11) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Negative Pressure Wound Therapy (for Nebraska Only) (CS157NE.N) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Negative Pressure Wound Therapy (for New Jersey Only) (CS157NJ.I) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Negative Pressure Wound Therapy (for New Mexico Only) (CS157NM.C) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Negative Pressure Wound Therapy (for Ohio Only) (CS157OH.E) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Negative Pressure Wound Therapy (for Pennsylvania Only) (CS157PA.K) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Negative Pressure Wound Therapy (for Tennessee Only) (CS157TN.K) | listed, no stance | Jul 1, 2026 | payer document |
Prior authorization required or conditional in 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.