15731 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 15731

2 of 2 payer prior-auth lists that name 15731 require prior authorization or set conditions: UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
UnitedHealthcare Community PlanNorth Carolina MedicaidNCprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of North Carolina Effective October 1, 2026 July 1, 2024
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of KentuckyKYprior auth requiredJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026

Payer coverage policies that name 15731

15731 appears in 15 coverage policies from Aetna, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaFacial Nerve Paralysis (0745)not coveredOct 30, 2025payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 10040-19499)Jul 29, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (MMP022.16)
Myocutaneous Flaps for Trunk, and Extremities		listed, no stanceSep 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (CS027.AD)listed, no stanceJul 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (MP.007.33)listed, no stanceJun 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (for Idaho Only) (CS027ID.C)
The following codes may be Cosmetic; review is required to determine if considered Cosmetic or		listed, no stanceMay 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (for Kansas Only) (CS027KS.03)listed, no stanceSep 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (for Kentucky Only) (CS027KY.13)listed, no stanceAug 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (for Nebraska Only) (CS027NE.U)listed, no stanceJul 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (for New Jersey Only) (CS027NJ.W)listed, no stanceJul 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (for New Mexico Only) (CS027NM.E)listed, no stanceJul 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (for North Carolina Only) (CSNC.MP.007.10)listed, no stanceJul 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (for Ohio Only) (CS027OH.E)listed, no stanceAug 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (for Pennsylvania Only) (CS027PA.AD)listed, no stanceJul 1, 2026payer document
UnitedHealthcareCosmetic and Reconstructive Procedures (for Tennessee Only) (CS027TN.AB)listed, no stanceAug 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, Oxford Health Plans

Medicaid fee-for-service

Prior authorization required or conditional in CO, WV.

  • AZ: $1177.45 (asc), effective Oct 1, 2026
  • CO: $798.99 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $691.44 (physician, facility), effective Jan 1, 2026
  • IL: $677.89 (practitioner), effective Apr 1, 2024
  • IN: $767.79 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $309.50 (asc, facility), effective Jan 1, 2007
  • KY: $1894.49 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $1278.72 (asc), effective May 1, 2026
  • MS: $1565.86 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1116.80 (physician, facility), effective Aug 1, 2026
  • NE: $637.00 (asc), effective Jul 1, 2024
  • NY: $460.11 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $523.91 (physician, facility), effective Jan 1, 2024
  • OK: $1728.38 (asc), effective Jan 1, 2026
  • TX: $1457.62 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $760.13 (medical, facility), effective Jul 1, 2026
  • VT: $2751.56 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1567.17 (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.