S9098 Home phototherapy visit

Home visit, phototherapy services (e.g., bili-lite), including equipment rental, nursing services, blood draw, supplies, and other services, per diem

Medicare pricing for S9098

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for S9098

4 of 4 payer prior-auth lists that name S9098 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Humana.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross and Blue Shield of TexasTexas PA exemption (gold card), outpatient, fully insuredTXprior auth requiredGold-card exemption availableJul 1, 2026BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
HumanaHumana Healthy HorizonsFLprior auth requiredJan 1, 20271102002FL1026 FLHN8CBEN Humana Healthy Horizons in Florida Preauthorization and Notification List
HumanaHumana Healthy HorizonsKYprior auth requiredJan 1, 2027please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management

Payer coverage policies that name S9098

S9098 appears in 14 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Centene, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaNeonatal Hyperbilirubinemia (0332)covered if criteria are metJun 2, 2026payer document
AetnaSkilled Home Health Care Nursing Services (0201)listed, no stanceApr 22, 2026payer document
AetnaSkilled Home Private Duty Nursing Care (0136)listed, no stanceApr 7, 2026payer document
AnthemHome Phototherapy Devices for Neonatal Hyperbilirubinemia (CG-DME-12)covered if criteria are metAug 13, 2026payer document
Blue Cross & Blue Shield of MississippiPhototherapy (L.2.01.404)covered if criteria are metpayer document
CentenePhototherapy for Neonatal Hyperbilirubinemia (CP.MP.150)covered if criteria are metJun 1, 2026payer document
UnitedHealthcareHome Health Care Services (for Kentucky Only) (CS137KY.12)listed, no stanceJul 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (MP.022.28)listed, no stanceJul 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (CS137.X)listed, no stanceJul 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (for Kansas Only) (CS137KS.04)listed, no stanceSep 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (for Nebraska Only) (CS137NE.V)listed, no stanceJan 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (for New Mexico Only) (CS137NM.D)listed, no stanceSep 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (for Ohio Only) (CS137OH.E)listed, no stanceAug 1, 2026payer document
UnitedHealthcareHome Health, Skilled, and Custodial Care Services (for Tennessee Only) (CS137TN1.J)listed, no stanceJan 1, 2026payer document

Recent prior-auth changes

  • Jan 1, 2024: PA removed, humana:pa:commercial

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • ND: $0.00 (physician), effective Aug 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.