0545T CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 0545T

1 of 1 payer prior-auth lists that name 0545T require prior authorization or set conditions: HealthSpring.

PayerPlanStatePrior authConditionsSinceSource
HealthSpringMedicare AdvantageAllprior auth requiredAug 1, 20262026 Q4 Prior Authorization List

Payer coverage policies that name 0545T

0545T appears in 15 coverage policies from Aetna, Anthem, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Regence, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaPercutaneous Mitral Valve and Tricuspid Valve Repair (0880)not coveredAug 25, 2026payer document
AnthemTranscatheter Mitral, Pulmonary, and Tricuspid Heart Valve Procedures (SURG.00121)unproven / investigationalFeb 19, 2026payer document
Capital Blue CrossExperimental and Investigational Procedures (MP 4.002)
Procedure codes: Cardiac		listed, no stanceSep 1, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Category III Current Procedural Terminology (CPT®) Codes
CPT Codes 0054T, 0055T, 0071T, 0072T, 0075T, 0076T, 0095T, 0098T, 0100T, 0101T,		listed, no stanceJan 1, 2027payer document
RegenceTranscatheter Heart Valve Procedures for Mitral or Tricuspid Valve Disorders (Surgery 221)listed, no stanceJun 1, 2026payer document
UnitedHealthcareCategory III CPT Codes (MMP043.49)
including transseptal puncture | Policy titled		listed, no stanceSep 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (2026T0557FF)listed, no stanceJul 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (CS123.X)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Kansas Only) (CS123KS.03)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Kentucky Only) (CS123KY.14)listed, no stanceSep 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Nebraska Only) (CS123NE.V)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for New Mexico Only) (CS123NM.D)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Ohio Only) (CS123OH.F)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Pennsylvania Only) (CS123PA.X)listed, no stanceAug 1, 2026payer document
UnitedHealthcareTranscatheter Procedures for Heart Valve Conditions (for Tennessee Only) (CS123TN.W)listed, no stanceAug 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, Oxford Health Plans
  • Aug 1, 2026: PA added, HealthSpring
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • ND: $0.00 (physician), effective Aug 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 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.