20561 CPT® code: payer coverage and prior authorization21 of 21 payer prior-auth lists that name 20561 require prior authorization or set conditions: Blue Shield of California, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Passport by Molina Healthcare (Kentucky).
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Shield of California | Blue Shield commercial | CA | prior auth under conditions | CalPERS ASO only | Sep 1, 2026 | Prior Authorization List for Blue Shield |
| Humana | Humana MA and D-SNP | All | prior auth required | Jan 1, 2027 | Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List | |
| Molina Complete Care (Virginia) | Medicaid | VA | prior auth required | Apr 1, 2025 | Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 | |
| Molina Healthcare of California | Medicaid | CA | prior auth required | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 | |
| Molina Healthcare of Idaho | Medicaid | ID | prior auth required | Jan 1, 2025 | Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025 | |
| Molina Healthcare of Illinois | Medicaid | IL | prior auth required | Jan 1, 2022 | Molina Healthcare of Illinois Codification Grid Q3 2026 | |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Molina Healthcare of Michigan | Medicaid | MI | prior auth required | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 | |
| Molina Healthcare of Michigan | Exchange | MI | prior auth required | Jul 1, 2021 | Molina Healthcare of Michigan PA Matrix, effective 7/1/2021 | |
| Molina Healthcare of Mississippi | Medicaid | MS | prior auth required | Jan 1, 2025 | Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 | |
| Molina Healthcare of Nevada | Medicaid | NV | prior auth required | Oct 1, 2022 | Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 | |
| Molina Healthcare of New Mexico | Medicaid | NM | prior auth required | Jul 1, 2026 | New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026 | |
| Molina Healthcare of Ohio | Medicaid and MyCare Ohio (MMP) Medicaid | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Medicare and MyCare Ohio (MMP) Medicare | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Ohio | Exchange | OH | prior auth required | Oct 1, 2023 | Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 | |
| Molina Healthcare of Texas | STAR | TX | prior auth required | Feb 19, 2025 | Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19 | |
| Molina Healthcare of Texas | STAR+PLUS | TX | prior auth required | Feb 19, 2025 | Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19 | |
| Molina Healthcare of Texas | STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix) | TX | prior auth required | Apr 1, 2020 | Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3 | |
| Molina Healthcare of Texas | Exchange | TX | prior auth required | Apr 1, 2020 | Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026 | |
| Molina Healthcare of Utah | Medicaid | UT | prior auth required | Jan 1, 2025 | Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025 | |
| Passport by Molina Healthcare (Kentucky) | Medicaid | KY | prior auth required | Jul 1, 2026 | Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026 |
20561 appears in 20 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Acupuncture and Dry Needling (0135) | not covered | Mar 25, 2026 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) Discseel procedure, DiscoGel (intradiscal alcohol injection), intradiscal injection of local anesthetic | not covered | Oct 6, 2026 | payer document |
| Aetna | Blood and Adipose Tissue Derived Products for Selected Indications (0784) | listed, no stance | Nov 19, 2025 | payer document |
| Aetna | Chiropractic Services (0107) | listed, no stance | Apr 7, 2026 | payer document |
| Aetna | Cold Laser and High-Power Laser Therapies (0363) | listed, no stance | Jul 15, 2026 | payer document |
| Aetna | Plantar Fasciitis Treatments (0235) | not covered | Apr 27, 2026 | payer document |
| Aetna | Remote Ischemic Conditioning (0814) | listed, no stance (range 20000-29999) | Nov 20, 2025 | payer document |
| Aetna | Skin and Soft Tissue Substitutes (0244) | not covered (range 20100-29999) | Jul 29, 2026 | payer document |
| Aetna | Spasticity Management (0362) | not covered | May 26, 2026 | payer document |
| Aetna | Temporomandibular Disorders (0028) | not covered | Mar 12, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Dry Needling Of Trigger Points For Myofascial Pain (A.2.01.100) | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Acupuncture and Dry Needling Services for Medicare Advantage Plans Dry Needling | covered if criteria are met | Jan 1, 2026 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Dry Needling of Trigger Points for Myofascial Pain | not covered | May 6, 2026 | payer document |
| Blue Cross Blue Shield of Massachusetts | Dry Needling and Trigger Point Injections for Myofascial Pain (792) | unproven / investigational | payer document | |
| Blue Shield of California | BSC8.08 | Occupational Therapy | listed, no stance | payer document | |
| Blue Shield of California | Dry Needling of Trigger Points for Myofascial Pain (2.01.100) | listed, no stance | payer document | |
| Centene | Trigger Point Injections for Pain Management (CP.MP.169) | not covered | Jul 1, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Dry Needling of Trigger Points for Myofascial Pain (SUR702.018) | listed, no stance | Sep 15, 2026 | payer document |
| Premera Blue Cross | Dry Needling of Trigger Points for Myofascial Pain (2.01.100) | listed, no stance | Jun 8, 2026 | payer document |
| Regence | Dry Needling (Medicine 39) | listed, no stance | Jan 1, 2026 | payer document |
Prior authorization required or conditional in CO, IN.
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.