31635 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 31635

1 of 1 payer prior-auth lists that name 31635 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross and Blue Shield of TexasTexas PA exemption (gold card), outpatient, fully insuredTXprior auth requiredGold-card exemption availableJul 1, 2026BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)

Payer coverage policies that name 31635

31635 appears in 3 coverage policies from Aetna, Blue Cross NC.

PayerPolicyRole in policyReviewedDocument
AetnaElectromagnetic Navigation-Guided Bronchoscopy (0776)listed, no stanceJun 8, 2026payer document
AetnaLung Imaging: Selected Techniques (0581)listed, no stanceSep 10, 2026payer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 3011F-3210F)Mar 1, 2024payer document

Medicaid fee-for-service

  • AZ: $499.77 (asc), effective Oct 1, 2026
  • CO: $135.75 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $359.62 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IL: $169.48 (practitioner), effective Apr 1, 2024
  • IN: $133.82 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $250.00 (asc, facility), effective Aug 1, 1982
  • KY: $823.65 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $519.94 (asc), effective May 1, 2026
  • MS: $633.71 (comprehensive, facility), effective Oct 1, 2025
  • ND: $485.54 (physician, facility), effective Aug 1, 2026
  • NE: $413.00 (asc), effective Jul 1, 2024
  • NY: $101.00 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $88.59 (physician, facility), effective Jan 1, 2024
  • OK: $751.43 (asc), effective Jan 1, 2026
  • TX: $525.71 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $137.15 (medical, facility), effective Jul 1, 2026
  • VT: $1382.02 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $308.28 (asc), effective Jul 1, 2026
  • WY: $787.13 (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.