Payer policies › CPT 9924599245 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 99245 Payer coverage policies that name 99245 99245 appears in 3 coverage policies from Anthem, Blue Cross NC, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Anthem Preoperative Testing for Low Risk Invasive Procedures and Surgeries (CG-MED-61) covered if criteria are met Aug 13, 2026 payer document Blue Cross NC Evaluation and Management Services listed, no stance (range 99202-99499) Jun 1, 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
Medicaid fee-for-service Prior authorization required or conditional in CO, IN, MD.
AZ: $26.78 (outpatient_hospital, RF133), effective Oct 1, 2025 CO: $187.06 (chp_plus, non-facility), effective Jul 1, 2026 FL: $138.98 (physician, facility), effective Jan 1, 2026 IL: $92.80 (podiatrist), effective Oct 1, 2014 KY: $150.75 (physician, facility), effective Jan 1, 2026 MA: $133.18 (physician_medicine, facility), effective May 1, 2024 MS: $196.83 (comprehensive, PCP), effective Jul 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 NE: $116.00 (behavioral_health, Advanced Practice Registered Nurse (APRN)), effective NY: $95.03 (physician_medicine, facility), effective Jul 1, 2026 OH: $94.48 (physician, facility), effective Jan 1, 2024 TX: $152.44 (family_planning_clinic, Family Planning Clinic, non-facility), effective Sep 1, 2007 VA: $128.89 (medical, facility), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $123.96 (enhanced_adult, 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.