`99075` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99075

Payer coverage policies that name 99075

99075 appears in 1 coverage policy from Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Premera Blue Cross	Non-covered Services and Procedures Page \| 10 of 30 \| ∞	listed, no stance	Jun 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

ND: $0.00 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $10.00 (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.

99075 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99075

Payer coverage policies that name 99075

Medicaid fee-for-service

`99075` CPT® code: payer coverage and prior authorization