31647 CPT® code: payer coverage and prior authorization
Payer policies and prior authorization for 31647
13 of 13 payer prior-auth lists that name 31647 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, CarePlus Health Plans, Humana, Rocky Mountain Health Plans.
Payer
Plan
State
Prior auth
Conditions
Since
Source
Blue Cross and Blue Shield of Texas
Texas PA exemption (gold card), outpatient, fully insured
31647 appears in 10 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.
Payer
Policy
Role in policy
Reviewed
Document
Aetna
Lung Denervation Therapy and Lung Volume Reduction Surgery (0160)
TX: $2295.85 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
VA: $160.30 (medical), effective Jul 1, 2026
VT: $5479.84 (outpatient_hospital_opps), effective Feb 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.