`99378` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99378

1 of 1 payer prior-auth lists that name 99378 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)

Payer coverage policies that name 99378

99378 appears in 1 coverage policy 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

Medicaid fee-for-service

Prior authorization required or conditional in IN.

AZ: $15.47 (outpatient_hospital, RF133), effective Oct 1, 2025
MA: $62.30 (physician_medicine, facility), effective May 1, 2024
ND: $0.00 (physician), effective Aug 1, 2026
TX: $86.48 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2023
VA: $22.10 (medical), effective Jan 1, 2007
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $50.88 (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.

99378 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99378

Payer coverage policies that name 99378

Medicaid fee-for-service

`99378` CPT® code: payer coverage and prior authorization