A2042 Foundation drs+ solo, sq cmFoundation drs+ solo (add-on, list separately in addition to primary procedure), per square centimeter
Status A: active, paid separately under the PFS if covered. National amounts: non-facility $127.26, facility $127.26 (total RVUs 3.81 / 3.81 × $33.4009 conversion factor; facility NA: rarely or never done in that setting). Work RVU 0.00, practice expense RVU 3.81 non-facility and 3.81 facility, malpractice RVU 0.00. Global period ZZZ. Qualifying APM participants are paid at a $33.5675 conversion factor.
8 of 8 payer prior-auth lists that name A2042 require prior authorization or set conditions: Blue Shield of California Promise Health Plan, HealthSpring, 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 Promise Health Plan | Promise Health Plan Medi-Cal | CA | prior auth required | Sep 1, 2026 | Medi-Cal Prior Authorization List | |
| HealthSpring | Medicare Advantage | All | prior auth required | Aug 1, 2026 | 2026 Q4 Prior Authorization List | |
| Molina Healthcare of Illinois | Medicaid | IL | prior auth required | Jul 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 | Jul 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 | Jul 1, 2026 | Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Apr 1, 2026 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 | |
| Passport by Molina Healthcare (Kentucky) | Medicaid | KY | prior auth required | Apr 1, 2026 | Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026 |
A2042 appears in 12 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, 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 Blue Shield of Massachusetts | Bioengineered Skin and Soft Tissue Substitutes (663) Procedure | unproven / investigational | payer document | |
| Blue Cross NC | Skin and Soft Tissue Substitutes | listed, no stance (range A2030-A2050) | 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 | 7 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 (2026T0592HH) | listed, no stance | Aug 1, 2026 | payer document |
Prior authorization required or conditional in OH.
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.