C1897 Lead, neurostim test kitLead, neurostimulator test kit (implantable)
8 of 8 payer prior-auth lists that name C1897 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Cigna, HealthSpring.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | AZ Blue-administered Medicare Advantage (M2K) | AZ | prior auth required | Sep 1, 2026 | AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026) | |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Standard PA code list (most commercial plans) | AZ | prior auth required | Sep 1, 2026 | AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026) | |
| Blue Cross Blue Shield of Arizona (AZ Blue) | State of Arizona employee group (SYD, S3Z) | AZ | prior auth required | Sep 1, 2026 | State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) | |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2016 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2016 | Master Precertification List (For Health Care Providers) |
| Cigna | Musculoskeletal | All | prior auth required | Mar 7, 2026 | Cigna Commercial Prior Authorization Procedure Code List: Musculoskeletal - Interventional Pain Management | |
| Cigna | Musculoskeletal | All | prior auth required | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs | |
| HealthSpring | Medicare Advantage | All | prior auth required | Jan 1, 2025 | 2026 Q4 Prior Authorization List |
C1897 appears in 21 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, Capital Blue Cross, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Deep Brain Stimulation (0208) | covered if criteria are met | Mar 27, 2026 | payer document |
| Aetna | Eating Disorders (0511) | not covered | Aug 4, 2026 | payer document |
| Aetna | Fecal Incontinence (0611) Acticon neosphincter | covered if criteria are met | Sep 23, 2026 | payer document |
| Aetna | Headaches: Invasive Procedures (0707) | not covered | Jul 23, 2026 | payer document |
| Aetna | Huntington's Disease (0614) | not covered | Sep 24, 2026 | payer document |
| Aetna | Motor Cortex Stimulation (0755) | not covered | Feb 24, 2026 | payer document |
| Aetna | Parkinson's Disease (0307) | not covered | Feb 24, 2026 | payer document |
| Aetna | Spinal Cord Stimulation (0194) | covered if criteria are met | Sep 10, 2026 | payer document |
| Aetna | Trigeminal Neuralgia: Treatments (0374) Topical ambroxol, Erenumab, Intravenous ketamine | not covered | Jun 29, 2026 | payer document |
| Aetna | Urinary Incontinence (0223) | covered if criteria are met | Jul 16, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Implantable Peripheral Nerve Stimulation For Chronic Pain Conditions | unproven / investigational | payer document | |
| Blue Shield of California | Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions (1.01.31) | listed, no stance | payer document | |
| Blue Shield of California | Spinal Cord and Dorsal Root Ganglion Stimulation (7.01.25) | listed, no stance | payer document | |
| Capital Blue Cross | Sacral Nerve Neuromodulation-Stimulation (MP 1.033) Procedure codes | covered if criteria are met | May 1, 2026 | payer document |
| Cigna | Deep Brain, Motor Cortex and Responsive Cortical Stimulation (0184) | covered if criteria are met | Nov 15, 2025 | payer document |
| Cigna | Deep Brain, Motor Cortex and Responsive Cortical Stimulation (0184) | unproven / investigational | Nov 15, 2025 | payer document |
| Cigna | Diaphragmatic/Phrenic Nerve Stimulation (0391) | covered if criteria are met | Jul 15, 2026 | payer document |
| Cigna | Peripheral Nerve Stimulation and Peripheral Nerve Field Stimulation (0539) | unproven / investigational | Mar 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Implantable Peripheral Nerve Stimulation for Chronic Pain Conditions (MED205.042) HCPCS Codes A4438, A4595, C1767, C1778, C1787, C1816, C1820, C1822, C1883, | listed, no stance | Jan 1, 2026 | payer document |
| Premera Blue Cross | Implantable Peripheral Nerve Stimulation for the Treatment of Chronic Pain and Other Conditions (7.01.574) | listed, no stance | Jul 1, 2026 | payer document |
| Premera Blue Cross | Spinal Cord and Dorsal Root Ganglion Stimulation (7.01.546) | listed, no stance | Jul 1, 2026 | payer document |
| Regence | Gastric Electrical Stimulation (Surgery 111) NOTES | listed, no stance | May 1, 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.