98928 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 98928

Payer coverage policies that name 98928

98928 appears in 20 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaAutism Spectrum Disorders (0648)not covered (range 98925-98929)Oct 2, 2025payer document
AetnaBreast Reduction Surgery and Gynecomastia Surgery (0017)listed, no stance (range 98925-98929)Mar 12, 2026payer document
AetnaGastroesophageal Reflux Disease (GERD) (0213)not covered (range 98925-98929)Jul 21, 2026payer document
AetnaHyperhidrosis (0504)not covered (range 98925-98929)Aug 11, 2026payer document
AetnaIdiopathic Scoliosis (0398)not covered (range 98925-98929)Sep 28, 2026payer document
AetnaNasolacrimal Duct Obstruction: Treatments (0420)not covered (range 98925-98929)Jul 7, 2026payer document
AetnaObstructive Sleep Apnea in Children (0752)not covered (range 98925-98929)Oct 30, 2025payer document
Blue Cross & Blue Shield of Rhode IslandPhysical and Occupational Servicescovered if criteria are metFeb 17, 2026payer 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 stanceJan 1, 2026payer document
UnitedHealthcareManipulative Therapy (2026T0541X)listed, no stanceJun 1, 2026payer document
UnitedHealthcareManipulative Therapy (CS076.P)listed, no stanceJun 1, 2026payer document
UnitedHealthcareManipulative Therapy (for Idaho Only) (CS076ID.C)listed, no stanceAug 1, 2026payer document
UnitedHealthcareManipulative Therapy (for Kansas Only) (CS076KS.03)listed, no stanceJun 1, 2026payer document
UnitedHealthcareManipulative Therapy (for Kentucky Only) (CS076KY.10)listed, no stanceJul 1, 2026payer document
UnitedHealthcareManipulative Therapy (for Nebraska Only) (CS076NE.O)listed, no stanceJun 1, 2026payer document
UnitedHealthcareManipulative Therapy (for New Mexico Only) (CS076NM.D)listed, no stanceJun 1, 2026payer document
UnitedHealthcareManipulative Therapy (for Ohio Only) (CS076OH.D)listed, no stanceJul 1, 2026payer document
UnitedHealthcareManipulative Therapy (for Pennsylvania Only) (CS076PA.P)listed, no stanceJul 1, 2026payer document
UnitedHealthcareManipulative Therapy (for Tennessee Only) (CS076TN.S)listed, no stanceSep 1, 2026payer document
UnitedHealthcareOsteopathic Manipulations (OMT) (MMP227.14)listed, no stanceSep 1, 2026payer document

Medicaid fee-for-service

  • AZ: $14.30 (outpatient_hospital, RF133), effective Oct 1, 2025
  • CO: $58.37 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $39.75 (physician, facility), effective Jan 1, 2026
  • IL: $39.35 (practitioner), effective Apr 1, 2024
  • IN: $45.73 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KY: $42.46 (physician, facility), effective Jan 1, 2026
  • MA: $42.81 (physician_medicine, facility), effective May 1, 2024
  • MS: $43.50 (comprehensive), effective Jul 1, 2026
  • ND: $81.11 (physician), effective Aug 1, 2026
  • NE: $64.40 (physician, facility), effective Jul 1, 2026
  • NY: $24.72 (physician_medicine, facility), effective Jul 1, 2026
  • OH: $29.76 (physician, facility), effective Jan 1, 2024
  • OK: $45.59 (physician, facility), effective Jul 1, 2026
  • TX: $48.56 (physician, Physician, facility), effective Sep 1, 2025
  • VA: $43.40 (medical, facility), effective Jul 1, 2026
  • VT: $16.77 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $29.43 (opps), effective Jul 1, 2026
  • WY: $9.55 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.