98978 CPT® code: payer coverage and prior authorization6 of 7 payer prior-auth lists that name 98978 require prior authorization or set conditions: Humana, Molina Healthcare of Iowa, Molina Healthcare of Ohio, Molina Healthcare of Texas.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Humana | Oak Street Health | All | prior auth required | Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management | ||
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Medicare and MyCare Ohio (MMP) Medicare | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Exchange | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Jan 1, 2023 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 |
98978 appears in 8 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Cigna, Molina Healthcare, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Remote Physiologic Monitoring (RPM) (1093) | listed, no stance | May 31, 2026 | payer document |
| Anthem | Remote Therapeutic and Physiologic Monitoring Services (CG-MED-91) | covered if criteria are met | Aug 13, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Digital Health Technologies For Attention Deficithyperactivity Disorder | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Digital Health Therapies For Substance Use Disorders (L.5.01.599) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Digital Health Therapies for Substance Use Disorders | not covered | Jul 2, 2025 | payer document |
| Cigna | Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) (0563) | listed, no stance | May 15, 2026 | payer document |
| Molina Healthcare | Remote Patient Monitoring Policy No. 419 (419) | listed, no stance | Oct 8, 2025 | payer document |
| Regence | Digital Therapeutic Products (Medicine 175) | listed, no stance | Mar 1, 2026 | payer document |
Prior authorization required or conditional in CO, IN, VA.
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.