99173 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99173

Payer coverage policies that name 99173

99173 appears in 5 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaChronic Vertigo (0238)covered if criteria are metApr 23, 2026payer document
AetnaCritical Flicker Fusion (0860)listed, no stanceDec 24, 2025payer document
AetnaVascular Endothelial Growth Factor Inhibitors for Ocular Indications (0701)listed, no stanceOct 5, 2026payer document
Blue Cross & Blue Shield of Rhode IslandVisual Screening for Children Ages 0-5 Yearscovered if criteria are metJan 1, 2014payer document
Premera Blue CrossPreventive Care
Vision acuity screening For all children
covered if criteria are metSep 21, 2026payer document

Medicaid fee-for-service

  • AZ: $3.73 (physician, AHCCCS PT 08, facility), effective Oct 1, 2024
  • CO: $2.43 (chp_plus, non-facility), effective Jul 1, 2026
  • IL: $7.45 (practitioner), effective Jul 1, 2026
  • IN: $2.41 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $3.75 (default, Exempt Physician), effective Mar 26, 2004
  • KY: $45.00 (physician, facility), effective Jan 1, 2026
  • LA: $10.00 (epsdt), effective Jul 1, 2015
  • MS: $2.55 (comprehensive), effective Jul 1, 2026
  • MT: $3.22 (optometric, facility), effective Jul 1, 2025
  • ND: $3.38 (physician), effective Aug 1, 2026
  • NE: $2.28 (physician, non-facility), effective Jul 1, 2026
  • OH: $2.40 (physician), effective Jan 1, 2018
  • OK: $2.76 (physician, non-facility), effective Jul 1, 2026
  • VA: $2.47 (medical), effective Jul 1, 2014
  • VT: $2.69 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $2.10 (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.