`S9123` Nursing care in home rn

Nursing care, in the home; by registered nurse, per hour (use for general nursing care only, not to be used when cpt codes 99500-99602 can be used)

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medicare pricing for S9123

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for S9123

64 of 65 payer prior-auth lists that name S9123 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Blue Shield of California, Cigna, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, 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 Texas, Molina Healthcare of Utah, Passport by Molina Healthcare (Kentucky), and others.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross Blue Shield of Arizona (AZ Blue)	Standard PA code list (most commercial plans)	AZ	prior auth required	Gold-card eligible	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	Gold-card eligible	Sep 1, 2026	State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	Teamsters group (TYW)	AZ	prior auth required	Gold-card eligible	Sep 1, 2026	Teamsters Group Prior Authorization Requirements Code List (Updated 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
Aetna	Medicare Advantage	All	prior auth required		Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth required		Oct 1, 2026	Participating provider precertification list for Aetna®
Cigna	ACA/IFP	All	prior auth required		Aug 17, 2009	Master Precertification List (For Health Care Providers)
Cigna	Basic Standard	All	prior auth required		Aug 17, 2009	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required		Aug 17, 2009	Master Precertification List (For Health Care Providers)
Cigna	Home Health	All	prior auth required	Intake only	Mar 7, 2026	Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
Cigna	Home Health	All	prior auth required	Intake only	Mar 7, 2026	Cigna Commercial Prior Authorization Procedure Code List: Home Health
Blue Cross and Blue Shield of Illinois	Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative)	IL	prior auth required		Jan 1, 2025	Procedure Code List, Effective 1/1/2025
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Sep 1, 2024	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
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 Healthy Horizons	FL	prior auth required		Jan 1, 2027	1102002FL1026 FLHN8CBEN Humana Healthy Horizons in Florida Preauthorization and Notification List
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	VA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
Humana	Oak Street Health	All	prior auth required			Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
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 California	Medicaid	CA	prior auth required		Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
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 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	PA required after initial 6 visits per rolling year for home health	Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023
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	Prior authorization is required for all home health services	Jul 1, 2026	New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026
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	Exchange	OH	prior auth required		Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
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 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	Medicaid	UT	prior auth required		Jan 1, 2025	Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth under conditions	PA after 6 snv	Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
UnitedHealthcare	UnitedHealthcare Medicare Advantage, Peoples Health and Dual Complete (D-SNP)	All	prior auth required		Oct 1, 2026	UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Medicare Advantage, Peoples Health and Dual Complete (D-SNP)	All	prior auth required		Oct 1, 2026	UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Medicare Advantage, Peoples Health and Dual Complete (D-SNP)	All	prior auth required		Oct 1, 2026	UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements Effective October 1, 2026
UnitedHealthcare Community Plan	AHCCCS Complete Care (ACC)	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Developmentally Disabled	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Long Term Care	AZ	prior auth under conditions	Infusion services – prior authorization is not required.	Oct 1, 2026	Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026
UnitedHealthcare Community Plan	Louisiana Medicaid (Healthy Louisiana)	LA	prior auth under conditions	site of care: home, outpatient	Jan 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Louisiana
UnitedHealthcare Community Plan	Maryland HealthChoice	MD	prior auth under conditions	site of care: home, outpatient	Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community Plan	Massachusetts OneCare	MA	prior auth under conditions	site of care: home, outpatient	Nov 1, 2025	Prior authorization requirements for Massachusetts OneCare Effective November 1, 2025
UnitedHealthcare Community Plan	Massachusetts Senior Care Options (SCO)	MA	prior auth under conditions	site of care: home, outpatient	Nov 1, 2025	CPT® is a registered trademark of the American Medical Association. Prior authorization requirements for Massachusetts Senior Care Options Effective November 1, 2025
UnitedHealthcare Community Plan	Mississippi CHIP	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community Plan	MississippiCAN	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025
UnitedHealthcare Community Plan	MississippiCAN	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025
UnitedHealthcare Community Plan	Nebraska Heritage Health	NE	prior auth under conditions	site of care: home, outpatient	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Nebraska Effective July 1, 2026 General Information This list contains prior authorization requirements for participating United
UnitedHealthcare Community Plan	New Jersey FamilyCare	NJ	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U
UnitedHealthcare Community Plan	New Mexico Turquoise Care	NM	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026
UnitedHealthcare Community Plan	North Carolina Medicaid	NC	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of North Carolina Effective October 1, 2026 July 1, 2024
UnitedHealthcare Community Plan	Pennsylvania CHIP	PA	prior auth under conditions	site of care: home, outpatient	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026
UnitedHealthcare Community Plan	Pennsylvania Medicaid	PA	prior auth under conditions	site of care: home, outpatient	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026
UnitedHealthcare Community Plan	Rhode Island Medicaid	RI	prior auth under conditions	site of care: home, outpatient	May 1, 2026	Prior authorization requirements for Rhode Island Medicaid Effective May 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan of Rhode Island h
UnitedHealthcare Community Plan	TennCare	TN	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Tennessee Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Florida	FL	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Kentucky	KY	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of New York	NY	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026
UnitedHealthcare Community Plan	Virginia Cardinal Care LTSS	VA	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior authorization requirements for Virginia Cardinal Care LTSS Effective October 1, 2026
UnitedHealthcare Community Plan	Washington Apple Health	WA	prior auth under conditions	site of care: home, outpatient	Oct 1, 2026	Prior authorization requirements for the UnitedHealthcare Community Plan of Washington Effective April 1, 2023
UnitedHealthcare Community Plan	Wisconsin BadgerCare Plus and Medicaid SSI	WI	prior auth under conditions	site of care: home, outpatient	Sep 1, 2026	Prior authorization requirements for Wisconsin Medicaid Effective September 1, 2026 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community

Payer coverage policies that name S9123

S9123 appears in 29 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Rhode Island, Centene, Premera Blue Cross, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Dialysis (0541)	covered if criteria are met	Aug 26, 2026	payer document
Aetna	Early Intervention Programs (0444)	not covered	Jul 1, 2026	payer document
Aetna	Home Births (0329)	not covered (range S9123-S9124)	May 21, 2026	payer document
Aetna	Nutritional Support (0061)	listed, no stance	Jan 15, 2026	payer document
Aetna	Skilled Home Health Care Nursing Services (0201)	covered if criteria are met	Apr 22, 2026	payer document
Aetna	Skilled Home Private Duty Nursing Care (0136)	listed, no stance	Apr 7, 2026	payer document
Aetna	Wound Care: Home or Outpatient Setting (1054)	covered if criteria are met	Dec 23, 2025	payer document
Anthem	Chronic Wound Care in the Home or Outpatient Setting (CG-MED-71)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Home Health (CG-MED-23)	covered if criteria are met	Nov 6, 2025	payer document
Anthem	Private Duty Nursing in the Home Setting (CG-REHAB-08)	covered if criteria are met	Aug 13, 2026	payer document
Blue Cross & Blue Shield of Rhode Island	DRAFT Home Health Care Services - Skilled Services	covered if criteria are met	Oct 1, 2026	payer document
Centene	Obstetrical Home Care Programs (CP.MP.91)	covered if criteria are met		payer document
Premera Blue Cross	Skilled Hourly Nursing Care in the Home	listed, no stance	Feb 9, 2026	payer document
UnitedHealthcare	Home Health Care Services (for Kentucky Only) (CS137KY.12)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (MP.022.28)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (CS137.X)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for Kansas Only) (CS137KS.04)	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for Nebraska Only) (CS137NE.V)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for New Jersey Only) (CS137NJ.X)	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for New Mexico Only) (CS137NM.D)	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for Ohio Only) (CS137OH.E)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Home Health, Skilled, and Custodial Care Services (for Tennessee Only) (CS137TN1.J)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (CS102.V)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (for Florida Only) (CS102FL.J)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (for Kansas Only) (CS102KS.03)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (for Nebraska Only) (CS102NE.Q)	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (for New Jersey Only) (CS102NJ.I)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (for New Mexico Only) (CS102NM.D)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Private Duty Nursing Services (for Ohio Only) (CS102OH.E)	listed, no stance	Oct 1, 2025	payer document

Recent prior-auth changes

Jan 1, 2027: PA added, Humana
Jul 1, 2026: conditions changed, Passport by Molina Healthcare (Kentucky)
Apr 1, 2026: PA removed, Blue Cross and Blue Shield of Illinois
Apr 1, 2026: PA removed, UnitedHealthcare Community Plan
Apr 1, 2026: PA removed, Blue Cross and Blue Shield of Illinois
Feb 1, 2026: PA added, uhc:pa:summary-of-changes
Feb 1, 2026: PA added, UnitedHealthcare
Oct 1, 2025: PA removed, UnitedHealthcare
Apr 1, 2025: conditions changed, UnitedHealthcare
Apr 1, 2025: conditions changed, Molina Complete Care (Virginia)

Medicaid fee-for-service

Prior authorization required or conditional in IN, LA, MS, ND, VA.

KS: $26.00 (school_lea), effective Jul 1, 2002
LA: $67.43 (home_health), effective Apr 3, 2023
MS: $19.55 (comprehensive), effective Jul 1, 2025
ND: $0.00 (physician), effective Aug 1, 2026
NE: $48.84 (behavioral_health, Advanced Practice Registered Nurse (APRN)), effective Jul 1, 2025
VA: $23.43 (medical, Iffds), effective Jul 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.

S9123 Nursing care in home rn