C8011 Opn mplnt hpgls ns ary recOpen implantation of hypoglossal nerve(s) neurostimulator electrode array(s) and receiver, including external power source and all system components
15 of 15 payer prior-auth lists that name C8011 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Cigna, Medicare.
| 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) | |
| Medicare | WISeR Model (Wasteful and Inappropriate Service Reduction) | AZ | prior auth required | Apr 6, 2026 | WISeR Model Provider and Supplier Operational Guide, Version 7.0 | |
| Medicare | WISeR Model (Wasteful and Inappropriate Service Reduction) | NJ | prior auth required | Apr 6, 2026 | WISeR Model Provider and Supplier Operational Guide, Version 7.0 | |
| Medicare | WISeR Model (Wasteful and Inappropriate Service Reduction) | OH | prior auth required | Apr 6, 2026 | WISeR Model Provider and Supplier Operational Guide, Version 7.0 | |
| Medicare | WISeR Model (Wasteful and Inappropriate Service Reduction) | OK | prior auth required | Apr 6, 2026 | WISeR Model Provider and Supplier Operational Guide, Version 7.0 | |
| Medicare | WISeR Model (Wasteful and Inappropriate Service Reduction) | TX | prior auth required | Apr 6, 2026 | WISeR Model Provider and Supplier Operational Guide, Version 7.0 | |
| Medicare | WISeR Model (Wasteful and Inappropriate Service Reduction) | WA | prior auth required | Apr 6, 2026 | WISeR Model Provider and Supplier Operational Guide, Version 7.0 | |
| Aetna | Medicare Advantage | All | prior auth required | Jul 1, 2026 | Participating provider precertification list for Aetna® | |
| Aetna | Commercial | All | prior auth required | Jul 1, 2026 | Participating provider precertification list for Aetna® | |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2026 | 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, 2026 | Master Precertification List (For Health Care Providers) |
| Cigna | Sleep | All | prior auth required | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs | |
| Cigna | Sleep | All | prior auth required | Mar 7, 2026 | Cigna Commercial Prior Authorization Procedure Code List: Sleep Management |
C8011 appears in 7 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Blue Shield of California, Capital Blue Cross, Cigna, Premera Blue Cross, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Obstructive Sleep Apnea in Adults (0004) | covered if criteria are met | Oct 6, 2026 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome sa | covered if criteria are met | Apr 1, 2026 | payer document |
| Blue Shield of California | Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome (7.01.101) | listed, no stance | payer document | |
| Capital Blue Cross | Surgical Treatment of Sleep Apnea and Snoring (MP 1.128) Procedure codes | covered if criteria are met | Apr 1, 2026 | payer document |
| Cigna | Surgical Treatments for Obstructive Sleep Apnea (0158) | listed, no stance | Jun 15, 2026 | payer document |
| Premera Blue Cross | Surgical Treatment of Snoring and Obstructive Sleep Apnea Syndrome (7.01.554) | listed, no stance | Jul 27, 2026 | payer document |
| Regence | Hypoglossal Nerve Stimulation (Surgery 215) | listed, no stance | Mar 1, 2026 | payer document |
Prior authorization required or conditional in IN, VT.
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.