Payer policies › CPT 2211622116 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 22116 9 of 9 payer prior-auth lists that name 22116 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Humana, Neighborhood Health Partnership, UnitedHealthcare, UnitedHealthcare Community Plan.
Payer Plan State Prior auth Conditions Since Source Blue Cross Blue Shield of Arizona (AZ Blue) Federal Employee Program (FEP) AZ prior auth under conditions FEP Blue Focus only Sep 1, 2026 Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026) Humana Humana Healthy Horizons IN prior auth required Jan 1, 2027 1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a Humana Humana Healthy Horizons KY prior auth required Jan 1, 2027 please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Humana Oak Street Health All prior auth required Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management Neighborhood Health Partnership Neighborhood Health Partnership FL prior auth required Sep 1, 2026 Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 UnitedHealthcare UnitedHealthcare Complete (Individual & Family plans) All prior auth required Sep 1, 2026 Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 UnitedHealthcare Community Plan UnitedHealthcare Community Plan of Kentucky KY prior auth required Jul 1, 2026 Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026 UnitedHealthcare Community Plan UnitedHealthcare Connected (Texas MMP) TX prior auth required Jan 1, 2015 Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U
Payer coverage policies that name 22116 22116 appears in 5 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Intraoperative Neurophysiological Monitoring (0697) covered if criteria are met (range 22100-22116) Jun 19, 2026 payer document Aetna Intraoperative Neurophysiological Monitoring (0697) not covered (range 22010-22899) Jun 19, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance (range 22010-22899) Jul 23, 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 Spinal Surgery: Laminectomy and Fusion (0743) covered if criteria are met Jul 30, 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, Surest Oct 1, 2026: PA removed, Oxford Health Plans Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Apr 1, 2026: PA removed, UnitedHealthcare Community Plan Medicaid fee-for-service AZ: $144.35 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $113.81 (chp_plus, non-facility), effective Jul 1, 2026 FL: $98.35 (physician, non-facility), effective Jan 1, 2026 IL: $503.70 (practitioner), effective Apr 1, 2024 IN: $103.98 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $84.33 (default, Exempt Physician), effective Aug 1, 2024 KY: $136.10 (physician, facility), effective Jan 1, 2026 LA: $114.90 (professional), effective Jul 1, 2025 MA: $102.06 (physician_surgery), effective May 1, 2024 MS: $104.23 (comprehensive), effective Jul 1, 2026 ND: $124.66 (physician), effective Aug 1, 2026 NE: $251.94 (physician, non-facility), effective Jul 1, 2026 NY: $70.58 (physician_surgery, facility), effective Jul 1, 2026 OH: $120.25 (physician), effective Jan 1, 2000 OK: $110.09 (physician, non-facility), effective Jul 1, 2026 TX: $17.68 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2026 VA: $109.09 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $71.28 (physician, facility), effective Jul 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.