HCPCS Level II › A codes A2017 Permeaderm glove, eachPermeaderm glove, each
Medicare coverage: Carrier judgment Status: active (October 2026 file) Medicare pricing for A2017 Physician Fee Schedule (CY 2026, RVU26D) Status C: contractor-priced by the MAC.
Payer policies and prior authorization for A2017 21 of 21 payer prior-auth lists that name A2017 require prior authorization or set conditions: Blue Shield of California, CarePlus Health Plans, HealthSpring, Humana, Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Molina Healthcare of New Mexico, Molina Healthcare of Texas, Passport by Molina Healthcare (Kentucky).
Payer Plan State Prior auth Conditions Since Source Blue Shield of California Blue Shield Medicare CA prior auth required Sep 1, 2026 Prior Authorization List for Blue Shield Medicare HealthSpring Medicare Advantage All prior auth required Jan 1, 2025 2026 Q4 Prior Authorization List CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana Healthy Horizons IN prior auth required Jan 1, 2027 1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a Humana Humana Healthy Horizons VA prior auth required Jan 1, 2027 Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management Molina Healthcare of California Medicaid CA prior auth required Apr 1, 2026 Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 Molina Healthcare of Illinois Medicaid IL prior auth required Jan 1, 2026 Molina Healthcare of Illinois Codification Grid Q3 2026 Molina Healthcare of Michigan Medicaid MI prior auth required Jul 1, 2026 Molina Healthcare of Michigan PA Matrix 2026-Q3 Molina Healthcare of New Mexico Medicaid NM prior auth required Jan 1, 2026 New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026 Molina Healthcare of Texas STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix) TX prior auth required Refer to Texas Medicaid Provider Procedures Manual for skin substitute limitations Jan 1, 2026 Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 Molina Healthcare of Texas Exchange TX prior auth required Jan 1, 2026 Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 Passport by Molina Healthcare (Kentucky) Medicaid KY prior auth required Jan 1, 2026 Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
Payer coverage policies that name A2017 A2017 appears in 21 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Blue Shield of California, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Skin and Soft Tissue Substitutes (0244) not covered Jul 29, 2026 payer document Anthem Products for Wound Healing and Soft Tissue Grafting: Investigational (SURG.00011) unproven / investigational Aug 13, 2026 payer document Blue Cross & Blue Shield of Mississippi Bioengineered Skin And Soft Tissue Substitutes (A.7.01.113) unproven / investigational payer document Blue Cross NC Skin and Soft Tissue Substitutes listed, no stance (range A2001-A2026) Aug 1, 2026 payer document Blue Shield of California Bioengineered Skin and Soft Tissue Substitutes (7.01.113) listed, no stance payer document Centene Skin and Soft Tissue Substitutes (CP.MP.185) not covered Apr 1, 2026 payer document Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) Bioengineered Skin and Soft Tissue Substitutes (SUR704.012)HCPCS Codes A2002, A2004, A2005, A2006, A2007, A2008, A2009, A2010, A2011, listed, no stance Jul 1, 2026 payer document Premera Blue Cross Bioengineered Skin and Soft Tissue Substitutes (7.01.582)Page | 6 of 41 | ∞ unproven / investigational Oct 1, 2026 payer document Regence Bioengineered Skin and Soft Tissue Substitutes and Amniotic Products (Medicine 170) listed, no stance Jun 1, 2026 payer document UnitedHealthcare Skin Substitutes Grafts/Cellular and Tissue-Based Products (Injections and/or Applications) (MMP105.22) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Skin and Soft Tissue Substitutes (CS153.AB) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Skin and Soft Tissue Substitutes (2026T0592HH) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Skin and Soft Tissue Substitutes (for Idaho Only) (CS153ID.E) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Skin and Soft Tissue Substitutes (for Kansas Only) (CS153KS.05) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Skin and Soft Tissue Substitutes (for Kentucky Only) (CS153KY.21) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Skin and Soft Tissue Substitutes (for Nebraska Only) (CS153NE.V) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Skin and Soft Tissue Substitutes (for New Jersey Only) (CS153NJ.X) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Skin and Soft Tissue Substitutes (for New Mexico Only) (CS153NM.H) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Skin and Soft Tissue Substitutes (for Ohio Only) (CS153OH.I) listed, no stance Apr 1, 2026 payer document UnitedHealthcare Skin and Soft Tissue Substitutes (for Pennsylvania Only) (CS153PA.Y) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Skin and Soft Tissue Substitutes (for Tennessee Only) (CS153TN.Z) listed, no stance Aug 1, 2026 payer document
Recent prior-auth changes Jan 1, 2027: PA added, Humana Jul 1, 2026: PA added, Molina Healthcare of Texas Jul 1, 2026: PA removed, Molina Healthcare of Michigan Mar 1, 2026: PA removed, Humana Jan 1, 2026: PA added, Passport by Molina Healthcare (Kentucky) Jan 1, 2026: PA added, Molina Healthcare of Illinois Jan 1, 2026: PA added, Molina Healthcare of Michigan Jan 1, 2026: PA added, Molina Healthcare of Michigan Medicaid fee-for-service Prior authorization required or conditional in OH.
IN: $42.97 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 ND: $0.00 (physician), effective Aug 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.