99342 CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 99342 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross and Blue Shield of Texas | Texas PA exemption (gold card), outpatient, fully insured | TX | prior auth required | Gold-card exemption available | Jul 1, 2026 | BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range) |
99342 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Home Behavioral Healthcare Services (0730) | listed, no stance | Nov 26, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | Evaluation And Management Home Visit (L.2.01.436) | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Mississippi | Parenteral Pen And Enteral En Nutrition Support In The Home (L.1.01.404) | covered if criteria are met | payer document | |
| Blue Cross NC | Evaluation and Management Services | listed, no stance (range 99202-99499) | Jun 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.