99174 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99174

1 of 1 payer prior-auth lists that name 99174 require prior authorization or set conditions: UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
UnitedHealthcare Community PlanUnitedHealthcare Connected (Texas MMP)TXprior auth requiredJan 1, 2015Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U

Payer coverage policies that name 99174

99174 appears in 15 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, BlueCross BlueShield of South Carolina, Premera Blue Cross, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaOcular Photoscreening (0689)covered if criteria are metDec 29, 2025payer document
Blue Cross & Blue Shield of Rhode IslandVisual Screening for Children Ages 0-5 Yearscovered if criteria are metJan 1, 2014payer document
BlueCross BlueShield of South CarolinaOcular Photoscreening in the Primary Care Physician's Office as a Screening Tool To Detect Amblyogenic Factors (CAM 90312)listed, no stanceSep 1, 2026payer document
Premera Blue CrossPreventive Care
Vision acuity screening For all children		covered if criteria are metSep 21, 2026payer document
UnitedHealthcareOcular Photoscreening (2026T0660F)listed, no stanceJun 1, 2026payer document
UnitedHealthcareOcular Photoscreening (CS378.C)listed, no stanceJun 1, 2026payer document
UnitedHealthcareOcular Photoscreening (for Idaho Only) (CS378ID.C)listed, no stanceAug 1, 2026payer document
UnitedHealthcareOcular Photoscreening (for Kansas Only) (CS378KS.03)listed, no stanceJun 1, 2026payer document
UnitedHealthcareOcular Photoscreening (for Kentucky Only) (CS378KY.03)listed, no stanceJun 1, 2026payer document
UnitedHealthcareOcular Photoscreening (for Nebraska Only) (CS378NE.C)listed, no stanceJun 1, 2026payer document
UnitedHealthcareOcular Photoscreening (for New Jersey Only) (CS378NJ.C)listed, no stanceJul 1, 2026payer document
UnitedHealthcareOcular Photoscreening (for New Mexico Only) (CS378NM.C)listed, no stanceJun 1, 2026payer document
UnitedHealthcareOcular Photoscreening (for Ohio Only) (CS378OH.C)listed, no stanceJul 1, 2026payer document
UnitedHealthcareOcular Photoscreening (for Pennsylvania Only) (CS378PA.C)listed, no stanceJul 1, 2026payer document
UnitedHealthcareOcular Photoscreening (for Tennessee Only) (CS378TN.C)listed, no stanceJul 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, Oxford Health Plans
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans

Medicaid fee-for-service

  • AZ: $6.28 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $5.33 (chp_plus, non-facility), effective Jul 1, 2026
  • IL: $7.45 (practitioner), effective Jul 1, 2014
  • IN: $4.70 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KY: $45.00 (asc), effective Jan 1, 2026
  • MA: $4.75 (physician_medicine), effective May 1, 2024
  • ND: $0.00 (physician), effective Aug 1, 2026
  • OH: $5.88 (physician), effective Jan 1, 2024
  • VA: $5.79 (medical), effective Jul 1, 2026
  • VT: $5.52 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $4.20 (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.