`S9990` Services provided as part of

Services provided as part of a phase ii clinical trial

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

Medicare pricing for S9990

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for S9990

30 of 30 payer prior-auth lists that name S9990 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Shield of California, Neighborhood Health Partnership, Oxford Health Plans, Surest, UnitedHealthcare, UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Since	Source
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)
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
Neighborhood Health Partnership	Neighborhood Health Partnership	FL	prior auth required	Sep 1, 2026	Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Oxford Health Plans	Oxford Health Plans	All	prior auth required	Oct 1, 2026	Prior Authorization Requirements for Oxford Effective October 1, 2026
Surest	Surest health plans	All	prior auth required	Oct 1, 2026	Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Commercial	All	prior auth required	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare commercial plans 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	UnitedHealthcare Mid-Atlantic Health Plans	All	prior auth required	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare West commercial plans	All	prior auth required	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare of the River Valley	All	prior auth required	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare of the River Valley 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 required	Oct 1, 2026	Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026
UnitedHealthcare Community Plan	KanCare	KS	prior auth required	Oct 1, 2026	Prior authorization requirements for Kansas Medicaid Effective October 1, 2026
UnitedHealthcare Community Plan	Maryland HealthChoice	MD	prior auth required	Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community Plan	Minnesota Metro Medicaid	MN	prior auth required	Oct 1, 2024	Prior authorization requirements for Minnesota Medicaid Effective October 1, 2024
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	Nebraska Heritage Health	NE	prior auth required	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 required	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	Pennsylvania CHIP	PA	prior auth required	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 required	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Florida	FL	prior auth required	Oct 1, 2026	Prior authorization requirements for UnitedHeathcare Community Plan of Florida Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Hawaii (QUEST Integration)	HI	prior auth required	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Hawaii Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of New York	NY	prior auth required	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026
UnitedHealthcare Community Plan	Washington Apple Health	WA	prior auth required	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 required	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 S9990

S9990 appears in 14 coverage policies from Aetna, Molina Healthcare, Premera Blue Cross, Regence, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Clinical Trials, Coverage of Routine Patient Care Costs (0466)	listed, no stance	Jul 1, 2026	payer document
Molina Healthcare	RELATED POLICIES MCP-000: Evaluation of New Technology MCP-184: Experimental and Investigational Services	listed, no stance		payer document
Premera Blue Cross	Clinical Trials	listed, no stance	Feb 9, 2026	payer document
Regence	Coverage of Treatments Provided in a Clinical Trial (Medicine 150)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Clinical Trials (MP.006.27) Covered When Criteria Are Met	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Mandatory Medicaid Coverage of Routine Patient Costs in Qualifying Clinical Trials (CS018SS.V) Covered When Criteria Are Met	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Mandatory Medicaid Coverage of Routine Patient Costs in Qualifying Clinical Trials (for Idaho Only) (CS018ID.C) Covered When Criteria Are Met	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Mandatory Medicaid Coverage of Routine Patient Costs in Qualifying Clinical Trials (for Kansas Only) (CS018KS.03) Covered When Criteria Are Met	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Mandatory Medicaid Coverage of Routine Patient Costs in Qualifying Clinical Trials (for Kentucky Only) (CS018KY.06) Covered When Criteria Are Met	listed, no stance	Sep 1, 2025	payer document
UnitedHealthcare	Mandatory Medicaid Coverage of Routine Patient Costs in Qualifying Clinical Trials (for Nebraska Only) (CS018NE.W) Covered When Criteria Are Met	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Mandatory Medicaid Coverage of Routine Patient Costs in Qualifying Clinical Trials (for New Mexico Only) (CS018NM.D) Covered When Criteria Are Met	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Mandatory Medicaid Coverage of Routine Patient Costs in Qualifying Clinical Trials (for Ohio Only) (CS018OH.C) Covered When Criteria Are Met	listed, no stance	Oct 1, 2025	payer document
UnitedHealthcare	Mandatory Medicaid Coverage of Routine Patient Costs in Qualifying Clinical Trials (for Pennsylvania Only) (CS018PA.T) Covered When Criteria Are Met	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Mandatory Medicaid Coverage of Routine Patient Costs in Qualifying Clinical Trials (for Tennessee Only) (CS018TN.T) Covered When Criteria Are Met	listed, no stance	Sep 1, 2026	payer document

Recent prior-auth changes

Oct 1, 2025: conditions changed, Neighborhood Health Partnership
Nov 1, 2024: conditions changed, Neighborhood Health Partnership

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.

S9990 Services provided as part of