99407 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99407

Payer coverage policies that name 99407

99407 appears in 12 coverage policies from Aetna, Blue Cross NC, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaBack Pain - Invasive Procedures (0016)listed, no stance (range 99406-99407)Oct 6, 2026payer document
AetnaBenralizumab (Fasenra) (0925)listed, no stanceAug 25, 2026payer document
AetnaDepemokimab-ulaa (Exdensur) (1098)listed, no stanceAug 10, 2026payer document
AetnaIntensive Cardiac Rehabilitation Programs (0267)listed, no stance (range 99406-99407)May 14, 2026payer document
AetnaMepolizumab (Nucala) (0897)listed, no stanceAug 5, 2026payer document
AetnaNutritional Counseling (0049)listed, no stance (range 99401-99412)Mar 10, 2026payer document
AetnaOmalizumab (0670)listed, no stanceAug 21, 2026payer document
AetnaReslizumab (Cinqair) (0907)listed, no stanceAug 10, 2026payer document
AetnaSkin and Soft Tissue Substitutes (0244)listed, no stanceJul 29, 2026payer document
AetnaSpinal Surgery: Laminectomy and Fusion (0743)listed, no stanceJul 30, 2026payer document
Blue Cross NCEvaluation and Management Serviceslisted, no stance (range 99202-99499)Jun 1, 2026payer document
Premera Blue CrossPreventive Care
Tobacco use counseling and interventions		covered if criteria are metSep 21, 2026payer document

Medicaid fee-for-service

  • CO: $26.43 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $13.18 (midwife, facility), effective Jan 1, 2026
  • IL: $16.91 (practitioner), effective Apr 1, 2024
  • IN: $19.35 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $14.97 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $45.00 (asc), effective Jan 1, 2026
  • LA: $21.65 (professional), effective Dec 1, 2020
  • MA: $54.04 (physician_medicine, facility), effective May 1, 2024
  • MS: $24.46 (comprehensive), effective Jul 1, 2026
  • ND: $31.92 (physician), effective Aug 1, 2026
  • NE: $27.00 (physician, facility), effective Jul 1, 2026
  • NY: $25.72 (midwife, non-facility), effective Jul 1, 2026
  • OH: $29.48 (physician, facility), effective Jan 1, 2024
  • OK: $19.96 (physician, facility), effective Jul 1, 2026
  • TX: $20.07 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), facility), effective Jan 1, 2012
  • VA: $15.90 (medical, facility), effective Jul 1, 2026
  • VT: $29.09 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $15.24 (enhanced_adult, facility), effective Jul 1, 2026
  • WY: $16.57 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.