Payer policies › CPT 9938799387 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 99387 Payer coverage policies that name 99387 99387 appears in 3 coverage policies from Aetna, Blue Cross NC, Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Aetna Intensive Cardiac Rehabilitation Programs (0267) listed, no stance (range 99381-99397) May 14, 2026 payer document Blue Cross NC Evaluation and Management Services listed, no stance (range 99381-99397) Jun 1, 2026 payer document Blue Cross NC Evaluation and Management Services listed, no stance (range 99202-99499) Jun 1, 2026 payer document Premera Blue Cross Preventive CareProcedure Code(s) | Comments covered if criteria are met Sep 21, 2026 payer document Premera Blue Cross Preventive CarePregnancy Care covered if criteria are met (range 99381-99397) Sep 21, 2026 payer document
Medicaid fee-for-service AZ: $34.82 (outpatient_hospital, RF133), effective Oct 1, 2024 CO: $145.80 (chp_plus, non-facility), effective Jul 1, 2026 FL: $83.65 (physician, facility), effective Jan 1, 2026 IL: $66.40 (practitioner), effective Feb 1, 2009 IN: $95.71 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $24.53 (default, Exempt Physician), effective Aug 1, 2024 KY: $101.40 (physician, facility), effective Jan 1, 2026 LA: $98.57 (professional), effective Feb 1, 2013 MA: $99.28 (physician_medicine, facility), effective May 1, 2024 MS: $156.47 (comprehensive, PCP), effective Jul 1, 2026 ND: $185.87 (physician), effective Aug 1, 2026 NE: $96.86 (physician, facility), effective Jul 1, 2026 NY: $47.19 (nurse_practitioner, facility), effective Jul 1, 2026 OH: $66.93 (physician, facility), effective Jan 1, 2024 OK: $97.15 (physician, facility), effective Jul 1, 2026 TX: $94.85 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Jan 1, 2010 VA: $77.09 (medical, facility), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 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.