31205 CPT® code: payer coverage and prior authorization2 of 2 payer prior-auth lists that name 31205 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 |
31205 appears in 6 coverage policies from Aetna, Blue Cross NC, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Grid Monitoring and Intraoperative Electroencephalography (0289) | listed, no stance (range 31200-31230) | Apr 17, 2026 | payer document |
| Aetna | Myringotomy and Tympanostomy Tube (0418) | listed, no stance (range 31000-31230) | Jun 30, 2026 | payer document |
| Aetna | Obstructive Sleep Apnea in Adults (0004) | not covered (range 30150-31235) | Oct 6, 2026 | payer document |
| Aetna | Tezepelumab-ekko (Tezspire) (1003) | listed, no stance (range 30000-31299) | Aug 6, 2026 | payer document |
| Blue Cross NC | Professional Pathology Billing Requirements AHS – R2169 | listed, no stance (range 3011F-3210F) | Mar 1, 2024 | payer document |
| Regence | Surgical Site of Care – Hospital Outpatient (Utilization Management 19) | listed, no stance | May 1, 2026 | payer document |
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.