`99172` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99172

Payer coverage policies that name 99172

99172 appears in 3 coverage policies from Aetna, Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Critical Flicker Fusion (0860)	listed, no stance	Dec 24, 2025	payer document
Aetna	Vascular Endothelial Growth Factor Inhibitors for Ocular Indications (0701)	listed, no stance	Oct 5, 2026	payer document
Premera Blue Cross	Preventive Care Vision acuity screening For all children	covered if criteria are met	Sep 21, 2026	payer document

Medicaid fee-for-service

CO: $50.64 (chp_plus, non-facility), effective Jul 1, 2026
IN: $10.65 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026
KY: $15.64 (physician, facility), effective Jan 1, 2026
LA: $73.16 (professional), effective Feb 1, 2013
ND: $0.00 (physician), effective Aug 1, 2026
NE: $36.56 (physician, non-facility), effective Jul 1, 2026
OH: $8.07 (physician, facility), effective Jan 1, 2018
VT: $0.00 (outpatient_hospital_opps), effective Feb 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.

99172 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99172

Payer coverage policies that name 99172

Medicaid fee-for-service

`99172` CPT® code: payer coverage and prior authorization