99239 CPT® code: payer coverage and prior authorization3 of 7 payer prior-auth lists that name 99239 require prior authorization or set conditions: Humana, Molina Healthcare of Iowa, Molina Healthcare of Nevada.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Humana | Humana Healthy Horizons | LA | prior auth required | Jan 1, 2027 | Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate | |
| 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 |
99239 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.