Payer policies › CPT 2290122901 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 22901 2 of 2 payer prior-auth lists that name 22901 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 22901 22901 appears in 4 coverage policies from Aetna, Regence.
Payer Policy Role in policy Reviewed Document Aetna Nerve Blocks (0863) listed, no stance (range 22900-22905) 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 Regence Surgical Site of Care – Hospital Outpatient (Utilization Management 19) listed, no stance May 1, 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, UnitedHealthcare Community Plan Oct 1, 2026: PA removed, Oxford Health Plans Aug 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, Neighborhood Health Partnership Jul 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, UnitedHealthcare Jun 1, 2026: conditions changed, UnitedHealthcare Medicaid fee-for-service AZ: $751.83 (asc), effective Oct 1, 2026 CO: $529.36 (chp_plus, non-facility), effective Jul 1, 2026 FL: $669.57 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $467.52 (practitioner), effective Apr 1, 2024 IN: $507.70 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $609.00 (asc, facility), effective Jan 1, 2010 KY: $1218.59 (asc), effective Jan 1, 2026 LA: $543.22 (professional), effective Jul 1, 2025 MA: $845.19 (asc), effective May 1, 2026 MS: $961.52 (comprehensive, facility), effective Oct 1, 2025 ND: $718.36 (physician, facility), effective Aug 1, 2026 NE: $785.00 (asc), effective Jul 1, 2024 NY: $333.96 (physician_surgery, facility), effective Jul 1, 2026 OH: $385.76 (physician), effective Jan 1, 2024 OK: $560.51 (physician, non-facility), effective Jul 1, 2026 TX: $815.20 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $555.85 (medical), effective Jul 1, 2026 VT: $2255.40 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $339.40 (asc), effective Jul 1, 2026 WY: $1284.57 (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.