98016 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 98016

Payer coverage policies that name 98016

98016 appears in 1 coverage policy from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaVulvodynia and Vulvar Vestibulitis Treatments (0759)not covered (range 97810-98714)Nov 12, 2025payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • AZ: $0.96 (outpatient_hospital, RF133), effective Oct 1, 2025
  • CO: $12.63 (chp_plus, non-facility), effective Jul 1, 2026
  • KY: $12.48 (physician, facility), effective Jan 1, 2026
  • ND: $0.00 (physician), effective Aug 1, 2026
  • NY: $16.44 (midwife, facility), effective Jul 1, 2026
  • OH: $11.23 (physician, facility), effective Jan 1, 2025
  • VA: $9.40 (medical, facility), effective Jul 1, 2026
  • VT: $10.75 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $7.64 (physician, facility), effective Jul 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.