99212 CPT® code: payer coverage and prior authorization2 of 5 payer prior-auth lists that name 99212 require prior authorization or set conditions: Molina Healthcare of Iowa, Molina Healthcare of Nevada.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | These CODES REQUIRE PA ONLY WHEN: PROVIDER IS NON PAR and it is not in one of the… | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 |
| Molina Healthcare of Nevada | Medicaid | NV | prior auth required | These CODES REQUIRE PA ONLY WHEN: PROVIDER IS NON PAR and it is not in one of the… | Oct 1, 2022 | Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 |
99212 appears in 10 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross NC, Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Autism Spectrum Disorders (0648) | listed, no stance (range 99201-99215) | Oct 2, 2025 | payer document |
| Aetna | Tourette's Syndrome (0480) | covered if criteria are met (range 99201-99215) | Jul 24, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Telehealth Storeandforward Telemedicine Services (L.2.04.438) | covered if criteria are met (range 99211-99215) | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Acupuncture Services for Commercial Products 2025 | covered if criteria are met | Nov 5, 2025 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Acupuncture and Dry Needling Services for Medicare Advantage Plans | covered if criteria are met | Jan 1, 2026 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Preventive Medicine and Other Evaluation and Management Office or Other Outpatient Services Medicare Advantage Plans and Commercial Products | listed, no stance (range 99202-99215) | Jun 18, 2025 | payer document |
| Blue Cross NC | Chiropractic Services | listed, no stance | Sep 1, 2025 | payer document |
| Blue Cross NC | Evaluation and Management Services | listed, no stance (range 99202-99499) | Jun 1, 2026 | payer document |
| Blue Cross NC | Evaluation and Management Services | listed, no stance (range 99202-99215) | Jun 1, 2026 | payer document |
| Premera Blue Cross | Preventive Care Pregnancy Care | covered if criteria are met (range 99211-99215) | Sep 21, 2026 | payer document |
| Premera Blue Cross | Preventive Care Breast biopsies and biopsy accessories | covered if criteria are met | Sep 21, 2026 | payer document |
| UnitedHealthcare | Preventive Care Services (MP.016.59) the diagnosis codes listed in this row: | benefits to apply. | listed, no stance | Jul 1, 2026 | payer document |
Prior authorization required or conditional in MD, WA.
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.