HCPCS Level II › C codes C9361 Neuromend nerve wrapCollagen matrix nerve wrap (neuromend collagen nerve wrap), per 0.5 centimeter length
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 10 units per day (clinical), rationale: Prescribing Information Outpatient hospital: max 10 units per day (clinical), rationale: Prescribing Information Payer policies and prior authorization for C9361 14 of 14 payer prior-auth lists that name C9361 require prior authorization or set conditions: CarePlus Health Plans, Humana, Rocky Mountain Health Plans.
Payer Plan State Prior auth Conditions Since Source 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 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 Healthy Horizons IN prior auth required Jan 1, 2027 1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a Humana Humana Healthy Horizons VA prior auth required Jan 1, 2027 Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL) 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 Rocky Mountain Health Plans Rocky Mountain Health Plans CHP+ CO prior auth required Oct 1, 2026 Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026 Rocky Mountain Health Plans Rocky Mountain Medicare Advantage D-SNP CO prior auth required Feb 1, 2025 Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
Payer coverage policies that name C9361 C9361 appears in 5 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
Payer Policy Role in policy Reviewed Document Aetna Nerve Grafting and Reconstruction: Selected Indications (0416) not covered Oct 6, 2026 payer document Aetna Skin and Soft Tissue Substitutes (0244) not covered Jul 29, 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 NC Skin and Soft Tissue Substitutes listed, no stance Aug 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
Recent prior-auth changes Jan 1, 2027: PA added, Humana Mar 1, 2026: PA removed, Humana Medicaid fee-for-service IN: $269.25 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 TX: $223.39 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Mar 1, 2025 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.