`99487` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99487

1 of 1 payer prior-auth lists that name 99487 require prior authorization or set conditions: Molina Healthcare of Texas.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Molina Healthcare of Texas	Exchange	TX	prior auth required		Jul 1, 2021	Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026

Payer coverage policies that name 99487

99487 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.

KY: $41.76 (physician, facility), effective Jan 1, 2026
MA: $66.81 (physician_medicine, facility), effective May 1, 2024
ND: $0.00 (physician), effective Aug 1, 2026
VT: $137.82 (outpatient_hospital_opps), effective Feb 1, 2026
WY: $78.50 (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.

99487 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 99487

Payer coverage policies that name 99487

Medicaid fee-for-service

`99487` CPT® code: payer coverage and prior authorization