27658 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 27658

3 of 3 payer prior-auth lists that name 27658 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Neighborhood Health Partnership, UnitedHealthcare.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)Federal Employee Program (FEP)AZprior auth under conditionsFEP Blue Focus onlySep 1, 2026Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)
Neighborhood Health PartnershipNeighborhood Health PartnershipFLprior auth under conditionssite of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WISep 1, 2026Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth under conditionssite of care: outpatient hospitalSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026

Payer coverage policies that name 27658

27658 appears in 17 coverage policies from Aetna, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 27600-27899)Jul 30, 2026payer document
AetnaIntraoperative Neurophysiological Monitoring (0697)not covered (range 27600-27899)Jun 19, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 27600-27899)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 27650-27692)Jul 29, 2026payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 20100-29999)Jul 29, 2026payer document
UnitedHealthcareSurgery of the Knee (2026T0553JJ)listed, no stanceSep 10, 2026payer document
UnitedHealthcareSurgery of the Knee (CS068.AD)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Idaho Only) (CS068ID.D)listed, no stanceAug 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Kansas Only) (CS068KS.05)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Kentucky Only) (CS068KY.13)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Nebraska Only) (CS068NE.AD)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for New Jersey Only) (CS068NJ.Z)listed, no stanceJul 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for New Mexico Only) (CS068NM.F)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for North Carolina Only) (CSNCT0553.08)listed, no stanceJun 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Ohio Only) (CS068OH.G)listed, no stanceJul 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Pennsylvania Only) (CS068PA.AA)listed, no stanceJul 1, 2026payer document
UnitedHealthcareSurgery of the Knee (for Tennessee Only) (CS068TN.AA)listed, no stanceJul 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, UnitedHealthcare Community Plan
  • Oct 1, 2026: PA removed, Oxford Health Plans
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • 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
  • Jul 1, 2026: conditions changed, UnitedHealthcare

Medicaid fee-for-service

  • AZ: $1062.88 (asc), effective Oct 1, 2026
  • CO: $298.88 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $277.69 (physician, non-facility), effective Jan 1, 2026
  • IL: $224.70 (podiatrist), effective Apr 1, 2024
  • IN: $290.69 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $350.00 (asc, facility), effective Aug 1, 1982
  • KY: $1605.64 (asc), effective Jan 1, 2026
  • LA: $233.58 (asc), effective Jul 1, 2012
  • MA: $1093.32 (asc), effective May 1, 2026
  • MS: $1263.33 (comprehensive, facility), effective Oct 1, 2025
  • ND: $946.52 (physician, facility), effective Aug 1, 2026
  • NE: $552.00 (asc), effective Jul 1, 2024
  • NY: $188.76 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $278.80 (physician), effective Jan 1, 2024
  • OK: $1464.86 (asc), effective Jan 1, 2026
  • TX: $1088.27 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $309.32 (medical), effective Jul 1, 2026
  • VT: $2540.58 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1447.00 (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.