Coverage and Limitation
2025 Coverage and Limitation Lists
The 2025 Coverage and Limitation List represents all the 2025 Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) and their code status. The code status will either be NPA for No Prior Authorization Required, PA for Prior Authorization Required, or NC for non-covered code. When you click into the URL below and the PDF populates, you can use Ctrl + F (control find) to search for whichever procedure code you are looking for to determine its coverage. For the most up to date configuration please use the 2025 Coverage & Limitation hyperlink.
More specific information on plan coverage and exclusions can also be accessed in our 2025 Member Evidence of Coverage.
If there are any additional questions, please reach out to our customer service team at 844-201-4672.