L8699 Prosthetic implant nosProsthetic implant, not otherwise specified
43 of 43 payer prior-auth lists that name L8699 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Shield of California, Humana, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of South Carolina, Molina Healthcare of Texas, Molina Healthcare of Utah, Molina Healthcare of Washington, Molina Healthcare of Wisconsin, and others.
| 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 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 | |
| Humana | Humana Healthy Horizons | KY | prior auth required | Jan 1, 2027 | please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. | |
| Humana | Humana Healthy Horizons | LA | prior auth required | Jan 1, 2027 | Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate | |
| Humana | Humana Healthy Horizons | OH | prior auth required | Jan 1, 2027 | 555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list | |
| Humana | Oak Street Health | All | prior auth required | Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management | ||
| Molina Complete Care (Virginia) | Medicare-only PA matrix for D-SNP | VA | prior auth required | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022 | |
| Molina Complete Care (Virginia) | Medicaid | VA | prior auth required | Apr 1, 2025 | Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 | |
| Molina Healthcare of Arizona | Medicare-only PA matrix for D-SNP | AZ | prior auth required | Jan 1, 2022 | Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022 | |
| Molina Healthcare of California | Medicaid | CA | prior auth required | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 | |
| Molina Healthcare of California | Medicare Advantage | CA | prior auth required | Jul 1, 2021 | Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021 | |
| Molina Healthcare of Florida | Medicare Advantage | FL | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021 | |
| Molina Healthcare of Idaho | Medicaid | ID | prior auth required | Jan 1, 2025 | Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025 | |
| Molina Healthcare of Idaho | Medicare Advantage | ID | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021 | |
| Molina Healthcare of Illinois | Medicaid | IL | prior auth required | Jan 1, 2022 | Molina Healthcare of Illinois Codification Grid Q3 2026 | |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Molina Healthcare of Michigan | Medicaid | MI | prior auth required | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 | |
| Molina Healthcare of Michigan | Medicare Advantage | MI | prior auth required | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 | |
| Molina Healthcare of Michigan | Exchange | MI | prior auth required | Jul 1, 2021 | Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 | |
| Molina Healthcare of Mississippi | Medicaid | MS | prior auth required | Jan 1, 2025 | Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 | |
| Molina Healthcare of Nevada | Medicaid | NV | prior auth required | Oct 1, 2022 | Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 | |
| Molina Healthcare of New Mexico | Medicaid | NM | prior auth required | Jul 1, 2026 | New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026 | |
| Molina Healthcare of New Mexico | Medicare Advantage | NM | prior auth required | Jan 1, 2021 | Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021 | |
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Medicare and MyCare Ohio (MMP) Medicare | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Exchange | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of South Carolina | Medicare Advantage | SC | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021 | |
| 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 | Jul 1, 2026 | Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 | |
| Molina Healthcare of Utah | Medicare Advantage | UT | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021 | |
| Molina Healthcare of Utah | Medicaid | UT | prior auth required | Jan 1, 2025 | Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025 | |
| Molina Healthcare of Washington | Medicare Advantage | WA | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021 | |
| Molina Healthcare of Wisconsin | Medicare Advantage | WI | prior auth required | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021 | |
| Molina Healthcare, Inc. (national grid) | Molina national (MHI) Medicare grid | All | prior auth required | Oct 1, 2021 | Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021 | |
| Passport by Molina Healthcare (Kentucky) | Medicaid | KY | prior auth required | Jul 1, 2026 | Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026 | |
| Oxford Health Plans | Oxford Health Plans | All | prior auth under conditions | Prior authorization required only for orthotics codes listed with a retail purchase or cumulative rental cost of more than $500. | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth required | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | Massachusetts OneCare | MA | prior auth under conditions | Prior authorization is required only for prosthetic codes listed with a retail purchase or cumulative rental cost of more than $1,000. | Nov 1, 2025 | Prior authorization requirements for Massachusetts OneCare Effective November 1, 2025 |
| UnitedHealthcare Community Plan | Ohio Medicaid | OH | prior auth required | Nov 1, 2025 | Prior authorization requirements for Ohio Medicaid Effective November 1, 2025 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community Plan | |
| UnitedHealthcare Community Plan | UnitedHealthcare Connected (Texas MMP) | TX | prior auth required | Jul 1, 2017 | Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U |
L8699 appears in 35 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Cochlear Implants and Auditory Brainstem Implants (0013) | listed, no stance | Aug 18, 2026 | payer document |
| Aetna | Gender Affirming Surgery (0615) | not covered | Sep 8, 2026 | payer document |
| Aetna | Hip Arthroplasty (0287) | not covered | Sep 23, 2026 | payer document |
| Anthem | Autologous Fat Grafting and Injectable Soft Tissue Fillers (CG-SURG-123) | covered if criteria are met | Nov 6, 2025 | payer document |
| Anthem | Cochlear Implants and Auditory Brainstem Implants (CG-SURG-81) | covered if criteria are met | May 14, 2026 | payer document |
| Anthem | Cosmetic and Reconstructive Services of the Head and Neck (ANC.00008) | covered if criteria are met | Aug 13, 2026 | payer document |
| Anthem | Cosmetic and Reconstructive Services of the Head and Neck (ANC.00008) | not covered | Aug 13, 2026 | payer document |
| Anthem | Osseointegrated Limb Prostheses (CG-OR-PR-10) | covered if criteria are met | Feb 19, 2026 | payer document |
| Anthem | Penile Prosthesis Implantation (CG-SURG-12) | covered if criteria are met | May 14, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Permanently Implanted Prostatic Devices For Benign Prostatic Hyperplasia (A.7.01.181) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Prosthetics (L.1.04.401) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Synthetic Cartilage Implants For Joint Pain (A.7.01.160) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Mississippi | Threedimensional Printed Orthopedic Implants (L.7.01.443) | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Synthetic Cartilage Implants for Joint Pain sad | not covered | Nov 1, 2019 | payer document |
| BlueCross BlueShield of South Carolina | Orthopedic Implants (CAM 385) | listed, no stance | Sep 1, 2026 | payer document |
| Cigna | Bone Graft Substitutes (0118) | listed, no stance | Feb 15, 2026 | payer document |
| Cigna | Cochlear Implants (0190) | covered if criteria are met | Nov 15, 2025 | payer document |
| Cigna | Metatarsophalangeal Joint Replacement (0446) | unproven / investigational | Sep 15, 2025 | payer document |
| Cigna | Miscellaneous Musculoskeletal Procedures (0515) | unproven / investigational | Jun 15, 2026 | payer document |
| Cigna | Pancreatic Islet Cell Transplantation (0107) | listed, no stance | Jun 15, 2026 | payer document |
| Cigna | Total Ankle Arthroplasty/Replacement (0285) | unproven / investigational | Mar 15, 2026 | payer document |
| Premera Blue Cross | (effective November 6, 2026) Cartilage Implants for Joint Pain (7.01.160) | listed, no stance | Jul 14, 2026 | payer document |
| Premera Blue Cross | Gender Transition/Affirmation Surgery and Related Services (7.01.557) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Omnibus Codes (MMP107.09) Prosthesis System | UnitedHealthcare | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Prostate Services and Procedures and Impotence Treatment (MMP075.14) Prostatic Urethral Lift (PUL) (e.g., UroLift® System) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (MP.019.34) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (CS107.AF) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Idaho Only) (CS107ID.C) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Kansas Only) (CS107KS.02) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Kentucky Only) (CS107KY.13) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Nebraska Only) (CS107NE.Y) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for New Jersey Only) (CS107NJ.AA) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for New Mexico Only) (CS107NM.C) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Ohio Only) (CS107OH.D) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Pennsylvania Only) (CS107PA.AE) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Rhinoplasty and Other Nasal Procedures (for Tennessee Only) (CS107TN.AE) | listed, no stance | May 1, 2026 | payer document |
Prior authorization required or conditional in CO, IN, MD, OH, VA, VT, WA.
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.