Payer policies › CPT 3209732097 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 32097 21 of 22 payer prior-auth lists that name 32097 require prior authorization or set conditions: CarePlus Health Plans, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Utah, Passport by Molina Healthcare (Kentucky).
Payer Plan State Prior auth Conditions Since Source CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification Molina Complete Care (Virginia) Medicaid VA prior auth required Apr 1, 2025 Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025 Molina Healthcare of California Medicaid CA prior auth required Apr 1, 2026 Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 Molina Healthcare of Illinois Medicaid IL prior auth required Jan 1, 2022 Molina Healthcare of Illinois Codification Grid Q3 2026 Molina Healthcare of Iowa Medicaid IA prior auth required Jul 1, 2023 IA Prior Authorization Matrix, effective Q3 2023 Molina Healthcare of Michigan Medicare Advantage MI prior auth required adults via Evolent Jul 1, 2026 Molina Healthcare of Michigan PA Matrix 2026-Q3 Molina Healthcare of Michigan Medicaid MI prior auth required adults via Evolent Jul 1, 2026 Molina Healthcare of Michigan PA Matrix 2026-Q3 Molina Healthcare of Mississippi Medicaid MS prior auth required adults via Evolent Jan 1, 2025 Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 Molina Healthcare of Nevada Medicaid NV prior auth required adults via NCH Oct 1, 2022 Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022 Molina Healthcare of New Mexico Medicaid NM prior auth required Jul 1, 2026 New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026 Molina Healthcare of Ohio Medicaid and MyCare Ohio (MMP) Medicaid OH prior auth under conditions no PA under 18 Oct 1, 2023 Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 Molina Healthcare of Ohio Exchange OH prior auth under conditions no PA under 18 Oct 1, 2023 Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01 Molina Healthcare of Utah Medicaid UT prior auth required Jan 1, 2025 Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025 Passport by Molina Healthcare (Kentucky) Medicaid KY prior auth required adults via Evolent Jul 1, 2026 Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
Payer coverage policies that name 32097 32097 appears in 5 coverage policies from Aetna, Blue Cross NC.
Payer Policy Role in policy Reviewed Document Aetna Anesthetic and Antiemetic Infusion Pumps (0607) listed, no stance (range 32035-32999) Sep 9, 2026 payer document Aetna Inpatient Admission Prior to Surgery (Preop Days) (0255) listed, no stance (range 32096-32160) May 13, 2026 payer document Aetna Positron Emission Tomography (PET) (0071) listed, no stance Sep 14, 2026 payer document Aetna Ultrasound Guidance – Selected Indications (0952) covered if criteria are met Apr 27, 2026 payer document Blue Cross NC Professional Pathology Billing Requirements AHS – R2169 listed, no stance (range 3011F-3210F) Mar 1, 2024 payer document
Recent prior-auth changes Jan 1, 2026: PA added, Molina Healthcare of Michigan Aug 30, 2024: PA removed, humana:pa:commercial Jan 1, 2024: PA added, Molina Healthcare of Michigan Medicaid fee-for-service AZ: $812.05 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $642.48 (chp_plus, non-facility), effective Jul 1, 2026 FL: $598.77 (physician, non-facility), effective Jan 1, 2026 IL: $560.21 (practitioner), effective Apr 1, 2024 IN: $596.72 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $344.80 (default, Exempt Physician), effective Aug 1, 2024 KY: $656.11 (physician, facility), effective Jan 1, 2026 LA: $660.05 (professional), effective Feb 1, 2013 MA: $579.08 (physician_surgery), effective May 1, 2024 MS: $640.00 (comprehensive), effective Jul 1, 2026 ND: $791.54 (physician), effective Aug 1, 2026 NE: $1037.40 (physician, non-facility), effective Jul 1, 2026 NY: $313.16 (physician_surgery, facility), effective Jul 1, 2026 OH: $407.84 (physician), effective Jan 1, 2024 OK: $676.55 (physician, non-facility), effective Jul 1, 2026 TX: $90.69 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $666.96 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $445.07 (physician, facility), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.