`T1016` Case management

Case management, each 15 minutes

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

Medicare pricing for T1016

Physician Fee Schedule (CY 2026, RVU26D)

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

Payer policies and prior authorization for T1016

3 of 3 payer prior-auth lists that name T1016 require prior authorization or set conditions: Blue Shield of California Promise Health Plan, Humana, Molina Healthcare of Iowa.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Shield of California Promise Health Plan	Promise Health Plan Medi-Cal	CA	prior auth required		Sep 1, 2026	Medi-Cal Prior Authorization List
Humana	Humana Healthy Horizons	FL	prior auth required		Jan 1, 2027	1102002FL1026 FLHN8CBEN Humana Healthy Horizons in Florida Preauthorization and Notification List
Molina Healthcare of Iowa	Medicaid	IA	prior auth required	PA required for Waiver services only, otherwise no PA required	Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023

Payer coverage policies that name T1016

T1016 appears in 1 coverage policy from Premera Blue Cross.

Payer	Policy	Role in policy	Reviewed	Document
Premera Blue Cross	Non-covered Services and Procedures Page \| 20 of 30 \| ∞	not covered	Jun 1, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN, MD, VA.

AZ: $19.67 (behavioral, AHCCCS PT 18), effective Oct 1, 2026
IN: $12.35 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2020
MS: $26.83 (comprehensive), effective Jul 1, 2023
ND: $0.00 (physician), effective Aug 1, 2026
VA: $367.31 (medical, Treatment Foster Care), effective Jul 1, 2021
WA: $4.59 (physician, facility), effective Jul 1, 2026
WY: $22.70 (professional), effective Jul 1, 2024

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.

T1016 Case management