C1734 Orth/devic/drug bn/bn,tis/bnOrthopedic/device/drug matrix for opposing bone-to-bone or soft tissue-to bone (implantable)
4 of 4 payer prior-auth lists that name C1734 require prior authorization or set conditions: Molina Healthcare of Texas.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Healthcare of Texas | STAR | TX | prior auth required | Feb 19, 2025 | Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19 | |
| Molina Healthcare of Texas | STAR+PLUS | TX | prior auth required | Feb 19, 2025 | Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19 | |
| Molina Healthcare of Texas | STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix) | TX | prior auth required | Apr 1, 2020 | Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 | |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Apr 1, 2020 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 |
C1734 appears in 8 coverage policies from Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, BlueCross BlueShield of South Carolina, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Anthem | Implantable Shock Absorber for Treatment of Knee Osteoarthritis (SURG.00162) | unproven / investigational | Feb 19, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Implantable Shock Absorbers For Treatment Of Knee Osteoarthritis | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Orthopedic Applications of Platelet-Rich Plasma a | not covered | May 6, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Orthopedic Applications of Platelet-Rich Plasma (CAM 20198) | listed, no stance | Jun 1, 2026 | payer document |
| Cigna | Bone Graft Substitutes (0118) | listed, no stance | Feb 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Orthopedic Applications of Platelet-Rich Plasma (RX501.101) | listed, no stance | Sep 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Use of a Medial Knee Implantable Shock Absorber (SUR705.051) | listed, no stance | May 1, 2026 | payer document |
| Premera Blue Cross | Implantable Shock Absorber for Treatment of Knee Osteoarthritis (7.01.90) | listed, no stance | Jul 14, 2026 | payer document |
Prior authorization required or conditional in IN.
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.