`99486` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99486

Payer coverage policies that name 99486

99486 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: $55.34 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
CO: $51.34 (chp_plus, non-facility), effective Jul 1, 2026
KY: $52.68 (physician, facility), effective Jan 1, 2026
MA: $46.82 (physician_medicine), effective May 1, 2024
ND: $0.00 (physician), effective Aug 1, 2026
VA: $39.95 (medical), 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.

99486 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99486

Payer coverage policies that name 99486

Medicaid fee-for-service

`99486` CPT® code: payer coverage and prior authorization