99221 CPT® code: payer coverage and prior authorization6 of 10 payer prior-auth lists that name 99221 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Molina Healthcare of Iowa, Molina Healthcare of Nevada.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | AZ Blue-administered Medicare Advantage (M2K) | AZ | prior auth required | Sep 1, 2026 | AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026) | |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Standard PA code list (most commercial plans) | AZ | prior auth under conditions | site of care: inpatient | Sep 1, 2026 | AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026) |
| Blue Cross Blue Shield of Arizona (AZ Blue) | State of Arizona employee group (SYD, S3Z) | AZ | prior auth under conditions | site of care: inpatient | Sep 1, 2026 | State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Teamsters group (TYW) | AZ | prior auth under conditions | site of care: inpatient | Sep 1, 2026 | Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026) |
| 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 |
99221 appears in 2 coverage policies from Blue Cross NC.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Blue Cross NC | Evaluation and Management Services | listed, no stance (range 99202-99499) | Jun 1, 2026 | payer document |
| Blue Cross NC | Observation Room Services | listed, no stance | Feb 1, 2026 | payer document |
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.