Payer policies › CPT 2544625446 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 25446 5 of 5 payer prior-auth lists that name 25446 require prior authorization or set conditions: Neighborhood Health Partnership, UnitedHealthcare, UnitedHealthcare Community Plan.
Payer Plan State Prior auth Conditions Since Source 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 Minnesota Metro Medicaid MN prior auth required Oct 1, 2024 Prior authorization requirements for Minnesota Medicaid Effective October 1, 2024 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 Jul 1, 2021 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 25446 25446 appears in 15 coverage policies from Aetna, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Intraoperative Neurophysiological Monitoring (0697) not covered (range 25000-25999) Jun 19, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance (range 25000-25999) 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) listed, no stance Jul 29, 2026 payer document Aetna Skin and Soft Tissue Substitutes (0244) not covered (range 20100-29999) Jul 29, 2026 payer document Aetna Wrist Arthroplasty (0853) covered if criteria are met Feb 25, 2026 payer document UnitedHealthcare Joint Procedures (MMP052.13)Surgery of the Hand or Wrist listed, no stance Jun 1, 2026 payer document UnitedHealthcare Surgery of the Wrist or Thumb (2026T0623M) listed, no stance Aug 1, 2026 payer document UnitedHealthcare Surgery of the Wrist or Thumb (CS343.J) listed, no stance Sep 1, 2026 payer document UnitedHealthcare Surgery of the Wrist or Thumb (for Idaho Only) (CS343ID.C) listed, no stance Sep 1, 2026 payer document UnitedHealthcare Surgery of the Wrist or Thumb (for Kansas Only) (CS343KS.03) listed, no stance Sep 1, 2026 payer document UnitedHealthcare Surgery of the Wrist or Thumb (for Kentucky Only) (CS343KY.09) listed, no stance Sep 1, 2026 payer document UnitedHealthcare Surgery of the Wrist or Thumb (for New Mexico Only) (CS343NM.D) listed, no stance Sep 1, 2026 payer document UnitedHealthcare Surgery of the Wrist or Thumb (for North Carolina Only) (CSNCT0558.05) listed, no stance Sep 1, 2026 payer document UnitedHealthcare Surgery of the Wrist or Thumb (for Ohio Only) (CS343OH.E) listed, no stance Sep 1, 2026 payer document UnitedHealthcare Surgery of the Wrist or Thumb (for Pennsylvania Only) (CS343PA.H) listed, no stance Sep 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, Surest Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Apr 1, 2026: PA removed, UnitedHealthcare Community Plan Medicaid fee-for-service Prior authorization required or conditional in WV.
AZ: $12875.88 (asc), effective Oct 1, 2026 CO: $938.06 (chp_plus, non-facility), effective Jul 1, 2026 FL: $820.12 (physician, non-facility), effective Jan 1, 2026 IL: $898.95 (practitioner), effective Jul 1, 2026 IN: $902.43 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $763.34 (default, Exempt Physician), effective Aug 1, 2024 KY: $14183.76 (asc), effective Jan 1, 2026 LA: $265.13 (asc), effective Jul 1, 2012 MA: $10925.06 (asc), effective May 1, 2026 MS: $11701.77 (comprehensive, facility), effective Oct 1, 2025 ND: $8361.34 (physician, facility), effective Aug 1, 2026 NE: $1662.00 (asc), effective Jul 1, 2024 NY: $568.62 (physician_surgery, facility), effective Jul 1, 2026 OH: $947.54 (physician), effective Jan 1, 2000 OK: $12940.14 (asc), effective Jan 1, 2026 TX: $10726.65 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $911.17 (medical), effective Jul 1, 2026 VT: $13614.33 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $647.27 (asc), effective Jul 1, 2026 WY: $7754.10 (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.