98012 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 98012

Payer coverage policies that name 98012

98012 appears in 2 coverage policies from Aetna, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaVulvodynia and Vulvar Vestibulitis Treatments (0759)not covered (range 97810-98714)Nov 12, 2025payer document
Premera Blue CrossPreventive Care
Pregnancy Care
covered if criteria are met (range 98005-98015)Sep 21, 2026payer document

Medicaid fee-for-service

  • AZ: $3.11 (outpatient_hospital, RF133), effective Oct 1, 2025
  • CO: $29.89 (chp_plus, non-facility), effective Jul 1, 2026
  • IN: $25.00 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KY: $26.38 (physician, facility), effective Jan 1, 2026
  • ND: $41.68 (physician), effective Aug 1, 2026
  • NE: $46.33 (behavioral_health, Advanced Practice Registered Nurse (APRN)), effective
  • OH: $23.73 (physician, facility), effective Jan 1, 2025
  • VA: $19.97 (medical, facility), effective Jul 1, 2026
  • VT: $25.46 (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.