99425 CPT® code: payer coverage and prior authorization1 of 1 payer prior-auth lists that name 99425 require prior authorization or set conditions: UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| UnitedHealthcare Community Plan | Washington Apple Health | WA | prior auth required | Oct 1, 2026 | Prior authorization requirements for the UnitedHealthcare Community Plan of Washington Effective April 1, 2023 |
99425 appears in 3 coverage policies from Blue Cross NC, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.
| 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 |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Custodial Care CPT Codes 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99424, | listed, no stance | May 1, 2026 | payer document |
| Premera Blue Cross | Preventive Care Breast biopsies and biopsy accessories | covered if criteria are met | Sep 21, 2026 | payer document |
Prior authorization required or conditional in IN, WA.
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.