Payer policies › CPT 1160411604 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 11604 2 of 2 payer prior-auth lists that name 11604 require prior authorization or set conditions: Neighborhood Health Partnership, UnitedHealthcare.
Payer Plan State Prior auth Conditions Since Source Neighborhood Health Partnership Neighborhood Health Partnership FL prior auth under conditions site of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WI Sep 1, 2026 Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 UnitedHealthcare UnitedHealthcare Complete (Individual & Family plans) All prior auth under conditions site of care: outpatient hospital Sep 1, 2026 Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
Payer coverage policies that name 11604 11604 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Skin and Soft Tissue Substitutes (0244) not covered (range 10040-19499) Jul 29, 2026 payer document
Recent prior-auth changes Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, Oxford Health Plans Aug 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, Neighborhood Health Partnership Jul 1, 2026: conditions changed, UnitedHealthcare Jun 1, 2026: conditions changed, UnitedHealthcare Apr 1, 2026: PA removed, UnitedHealthcare Community Plan Medicaid fee-for-service AZ: $248.66 (asc), effective Oct 1, 2026 CO: $233.68 (chp_plus, non-facility), effective Jul 1, 2026 FL: $147.29 (physician, facility), effective Jan 1, 2026 IL: $143.65 (practitioner), effective Apr 1, 2024 IN: $164.13 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $300.00 (asc, facility), effective Aug 1, 1982 KY: $379.28 (asc), effective Jan 1, 2026 LA: $182.30 (asc), effective Jul 1, 2012 MA: $262.00 (asc), effective May 1, 2026 MS: $302.08 (comprehensive, facility), effective Oct 1, 2025 ND: $223.59 (physician, facility), effective Aug 1, 2026 NE: $413.00 (asc), effective Jul 1, 2024 NY: $91.81 (physician_surgery, facility), effective Jul 1, 2026 OH: $110.75 (physician, facility), effective Jan 1, 2024 OK: $346.03 (asc), effective Jan 1, 2026 TX: $257.60 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $156.83 (medical, facility), effective Jul 1, 2026 VT: $549.84 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $308.28 (asc), effective Jul 1, 2026 WY: $313.16 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.