`99427` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99427

Payer coverage policies that name 99427

99427 appears in 2 coverage policies from Blue Cross NC, 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
Premera Blue Cross	Preventive Care Breast biopsies and biopsy accessories	covered if criteria are met	Sep 21, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

AZ: $13.59 (outpatient_hospital, RF133), effective Oct 1, 2024
KY: $29.25 (physician, facility), effective Jan 1, 2026
MA: $25.55 (physician_medicine, facility), effective May 1, 2024
ND: $0.00 (physician), effective Aug 1, 2026
NE: $56.86 (physician, non-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.

99427 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99427

Payer coverage policies that name 99427

Medicaid fee-for-service

`99427` CPT® code: payer coverage and prior authorization