`98011` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 98011

Payer coverage policies that name 98011

98011 appears in 2 coverage policies from Aetna, Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Vulvodynia and Vulvar Vestibulitis Treatments (0759)	not covered (range 97810-98714)	Nov 12, 2025	payer document
Premera Blue Cross	Preventive Care Pregnancy Care	covered if criteria are met (range 98005-98015)	Sep 21, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

AZ: $6.23 (outpatient_hospital, RF133), effective Oct 1, 2025
CO: $134.05 (chp_plus, non-facility), effective Jul 1, 2026
KY: $128.90 (physician, facility), effective Jan 1, 2026
ND: $186.24 (physician), effective Aug 1, 2026
VA: $98.78 (medical, facility), effective Jul 1, 2026
VT: $130.72 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

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.

98011 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 98011

Payer coverage policies that name 98011

Medicaid fee-for-service

`98011` CPT® code: payer coverage and prior authorization