26340 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 26340

8 of 8 payer prior-auth lists that name 26340 require prior authorization or set conditions: Neighborhood Health Partnership, Oxford Health Plans, Surest, UnitedHealthcare, UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
Neighborhood Health PartnershipNeighborhood Health PartnershipFLprior auth requiredSep 1, 2026Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Oxford Health PlansOxford Health PlansAllprior auth requiredOct 1, 2026Prior Authorization Requirements for Oxford Effective October 1, 2026
SurestSurest health plansAllprior auth requiredOct 1, 2026Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcareUnitedHealthcare CommercialAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare Mid-Atlantic Health PlansAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare West commercial plansAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare of the River ValleyAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026
UnitedHealthcare Community PlanUnitedHealthcare Connected (Texas MMP)TXprior auth requiredJan 1, 2015Prior 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 26340

26340 appears in 19 coverage policies from Aetna, Anthem, Cigna, Regence, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaManipulation Under General Anesthesia (0204)not coveredMar 25, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 26010-26989)Jul 23, 2026payer document
AetnaRemote Ischemic Conditioning (0814)listed, no stance (range 20000-29999)Nov 20, 2025payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 20100-29999)Jul 29, 2026payer document
AnthemManipulation Under Anesthesia (CG-MED-65)not coveredAug 13, 2026payer document
CignaManipulation Under Anesthesia (0276)covered if criteria are metSep 15, 2026payer document
CignaManipulation Under Anesthesia (0276)not coveredSep 15, 2026payer document
RegenceManipulation Under Anesthesia (Medicine 130)listed, no stanceOct 1, 2025payer document
UnitedHealthcareManipulation Under Anesthesia (2026T0515CC)listed, no stanceFeb 1, 2026payer document
UnitedHealthcareManipulation Under Anesthesia (CS075.U)listed, no stanceMar 1, 2026payer document
UnitedHealthcareManipulation Under Anesthesia (for Idaho Only) (CS075ID.C)listed, no stanceJun 1, 2026payer document
UnitedHealthcareManipulation Under Anesthesia (for Kansas Only) (CS075KS.02)listed, no stanceMar 1, 2026payer document
UnitedHealthcareManipulation Under Anesthesia (for Kentucky Only) (CS075KY.07)listed, no stanceMar 1, 2026payer document
UnitedHealthcareManipulation Under Anesthesia (for Nebraska Only) (CS075NE.U)listed, no stanceMar 1, 2026payer document
UnitedHealthcareManipulation Under Anesthesia (for New Jersey Only) (CS075NJ.P)listed, no stanceMar 1, 2026payer document
UnitedHealthcareManipulation Under Anesthesia (for New Mexico Only) (CS075NM.C)listed, no stanceMar 1, 2026payer document
UnitedHealthcareManipulation Under Anesthesia (for North Carolina Only) (CSNCT0515.04)listed, no stanceApr 1, 2026payer document
UnitedHealthcareManipulation Under Anesthesia (for Ohio Only) (CS075OH.D)listed, no stanceApr 1, 2026payer document
UnitedHealthcareManipulation Under Anesthesia (for Pennsylvania Only) (CS075PA.R)listed, no stanceApr 1, 2026payer document
UnitedHealthcareManipulation Under Anesthesia (for Tennessee Only) (CS075TN.R)listed, no stanceMar 1, 2026payer document

Medicaid fee-for-service

  • AZ: $504.49 (asc), effective Oct 1, 2026
  • CO: $294.77 (chp_plus, non-facility), effective Jul 1, 2026
  • IL: $242.23 (practitioner), effective Apr 1, 2024
  • IN: $284.44 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $300.00 (asc, facility), effective Jan 1, 2002
  • KY: $852.05 (asc), effective Jan 1, 2026
  • LA: $286.37 (professional), effective Jul 1, 2025
  • MA: $606.05 (asc), effective May 1, 2026
  • MS: $670.63 (comprehensive, facility), effective Oct 1, 2025
  • ND: $502.29 (physician, facility), effective Aug 1, 2026
  • NE: $333.44 (physician, non-facility), effective Jul 1, 2026
  • NY: $150.62 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $200.97 (physician), effective Jan 1, 2024
  • OK: $777.34 (asc), effective Jan 1, 2026
  • TX: $593.04 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $316.55 (medical), effective Jul 1, 2026
  • VT: $1248.54 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $308.28 (asc), effective Jul 1, 2026
  • WY: $711.11 (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.