HCPCS Level II › C codes C1896 Lead, aicd, non sing/dualLead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 2 units per day (clinical), rationale: Clinical: CMS Workgroup Outpatient hospital: max 2 units per day (clinical), rationale: Clinical: Data Payer policies and prior authorization for C1896 15 of 15 payer prior-auth lists that name C1896 require prior authorization or set conditions: Blue Shield of California, CarePlus Health Plans, Humana.
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 Blue Shield of California Blue Shield commercial CA prior auth required Sep 1, 2026 Prior Authorization List for Blue Shield 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 Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services Humana Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services Humana Cardiology Services All prior auth required Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services 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 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
Payer coverage policies that name C1896 C1896 appears in 3 coverage policies from Aetna, Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Aetna Cardiac Resynchronization Therapy and Other Pacing/Defibrillator Treatments for Heart Failure (0610) covered if criteria are met Sep 18, 2026 payer document Aetna Cardioverter-Defibrillators (0585) covered if criteria are met Apr 22, 2026 payer document Premera Blue Cross Implantable Cardioverter-Defibrillator (ICD) (7.01.44) listed, no stance Jul 27, 2026 payer document
Recent prior-auth changes Feb 1, 2024: PA removed, Blue Shield of California Promise Health Plan Medicaid fee-for-service Prior authorization required or conditional in IN.
KY: $0.00 (asc), effective Jan 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 OK: $0.00 (outpatient_hospital_apc), effective Jan 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.