98940 CPT® code: payer coverage and prior authorization7 of 7 payer prior-auth lists that name 98940 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Humana, Molina Healthcare of California, Molina Healthcare of Mississippi, Molina Healthcare of Texas, Rocky Mountain Health Plans, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross and Blue Shield of Illinois | Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative) | IL | prior auth required | eviCore-managed | Jan 1, 2025 | Procedure Code List, Effective 1/1/2025 |
| Humana | Humana MA and D-SNP | All | prior auth required | Jan 1, 2027 | Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List | |
| Molina Healthcare of California | Medicaid | CA | prior auth required | State exception | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 |
| Molina Healthcare of Mississippi | Mississippi state exceptions (exceptions only) | MS | prior auth under conditions | State exception; PA after 12 visits | Jan 1, 2025 | Mississippi code/benefit exceptions (Marketplace), 2025-Q1 |
| Molina Healthcare of Texas | Exchange | TX | prior auth under conditions | PA after 12 visits | Jan 1, 2024 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 |
| Rocky Mountain Health Plans | Rocky Mountain Medicare Advantage D-SNP | CO | prior auth required | Feb 1, 2025 | Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025 | |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Florida | FL | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026 |
98940 appears in 27 coverage policies from Aetna, Blue Cross NC, BlueCross BlueShield of South Carolina, Centene, Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Attention Deficit/Hyperactivity Disorder (0426) EEG theta/beta power ratio, Gut microbiota profile, polygenic risk score, evaluation of kynurenine pathway | not covered | Jul 7, 2026 | payer document |
| Aetna | Autism Spectrum Disorders (0648) | not covered (range 98940-98943) | Oct 2, 2025 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance | Oct 6, 2026 | payer document |
| Aetna | Breast Reduction Surgery and Gynecomastia Surgery (0017) | listed, no stance (range 98940-98943) | Mar 12, 2026 | payer document |
| Aetna | Chiropractic Services (0107) | covered if criteria are met | Apr 7, 2026 | payer document |
| Aetna | Complementary and Alternative Medicine (0388) | listed, no stance | Jun 25, 2026 | payer document |
| Aetna | Enuresis (0431) | not covered (range 98940-98943) | Jul 1, 2026 | payer document |
| Aetna | Idiopathic Scoliosis (0398) | not covered (range 98940-98943) | Sep 28, 2026 | payer document |
| Aetna | Obstructive Sleep Apnea in Children (0752) | not covered (range 98940-98943) | Oct 30, 2025 | payer document |
| Blue Cross NC | Chiropractic Services | listed, no stance (range 98940-98943) | Sep 1, 2025 | payer document |
| Blue Cross NC | Chiropractic Services | listed, no stance | Sep 1, 2025 | payer document |
| Blue Cross NC | Rehabilitative Therapies | listed, no stance (range 98940-98943) | Sep 1, 2025 | payer document |
| BlueCross BlueShield of South Carolina | Chiropractic Services (CAM 065) | listed, no stance | Jun 1, 2026 | payer document |
| Centene | Attention Deficit Hyperactivity Disorder Assessment and Treatment (CP.MP.124) | not covered | Feb 1, 2022 | payer document |
| Centene | Attention Deficit Hyperactivity Disorder Assessment and Treatment (CP.BH.124) | not covered | Mar 1, 2024 | payer document |
| Premera Blue Cross | Chiropractic and Other Manipulation Services (8.03.501) | listed, no stance | Feb 9, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (CS076.P) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (2026T0541X) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (for Idaho Only) (CS076ID.C) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (for Kansas Only) (CS076KS.03) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (for Kentucky Only) (CS076KY.10) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (for Nebraska Only) (CS076NE.O) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (for New Jersey Only) (CS076NJ.P) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (for New Mexico Only) (CS076NM.D) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (for North Carolina Only) (CSNCT0541.07) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (for Ohio Only) (CS076OH.D) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (for Pennsylvania Only) (CS076PA.P) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Manipulative Therapy (for Tennessee Only) (CS076TN.S) | listed, no stance | Sep 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.