31653 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 31653

1 of 1 payer prior-auth lists that name 31653 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 31653

31653 appears in 4 coverage policies from Aetna, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California.

PayerPolicyRole in policyReviewedDocument
AetnaEndoscopic Ultrasonography (0446)covered if criteria are met (range 31652-31653)Jul 22, 2026payer document
Blue Cross Blue Shield of MassachusettsEndobronchial Ultrasound for Diagnosis and Staging of Lung Cancer (715)listed, no stancepayer document
Blue Cross NCProfessional Pathology Billing Requirements AHS – R2169listed, no stance (range 3011F-3210F)Mar 1, 2024payer document
Blue Shield of CaliforniaEndobronchial Ultrasound for Diagnosis and Staging of Lung Cancer (6.01.58)listed, no stancepayer document

Medicaid fee-for-service

  • AZ: $1082.27 (asc), effective Oct 1, 2026
  • CO: $211.39 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $170.41 (physician, facility), effective Jan 1, 2026
  • IL: $164.63 (practitioner), effective Apr 1, 2024
  • IN: $186.76 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $724.01 (asc, facility), effective Jan 1, 2016
  • KY: $1655.96 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jan 1, 2016
  • MA: $1052.05 (asc), effective May 1, 2026
  • MS: $1288.25 (comprehensive, facility), effective Oct 1, 2025
  • ND: $976.19 (physician, facility), effective Aug 1, 2026
  • NE: $462.38 (physician, non-facility), effective Jul 1, 2026
  • NY: $142.30 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $209.30 (physician, facility), effective Jan 1, 2024
  • OK: $197.69 (physician, facility), effective Jul 1, 2026
  • TX: $1062.24 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $189.81 (medical, facility), effective Jul 1, 2026
  • VT: $2894.92 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1648.81 (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.