33222 CPT® code: payer coverage and prior authorization2 of 8 payer prior-auth lists that name 33222 require prior authorization or set conditions: Molina Healthcare of Ohio.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| 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 |
33222 appears in 15 coverage policies from Aetna, Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Anesthetic and Antiemetic Infusion Pumps (0607) | listed, no stance (range 33016-37799) | Sep 9, 2026 | payer document |
| Aetna | Bupivacaine Liposome (Exparel) (0941) | listed, no stance (range 33010-37799) | Jul 30, 2026 | payer document |
| Aetna | Cardiovascular Ultrafiltration (0741) | listed, no stance (range 33010-37790) | Oct 30, 2025 | payer document |
| Aetna | Cryoanalgesia and Therapeutic Cold (0297) | listed, no stance (range 33016-33999) | Apr 14, 2026 | payer document |
| Aetna | Functional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677) | listed, no stance (range 33016-33999) | Sep 10, 2026 | payer document |
| Aetna | Inpatient Admission Prior to Surgery (Preop Days) (0255) | listed, no stance (range 33016-33980) | May 13, 2026 | payer document |
| Aetna | Intravenous Iron Therapy (0575) | listed, no stance (range 33016-33999) | Jul 1, 2026 | payer document |
| Aetna | Negative Pressure Wound Therapy (0334) | listed, no stance (range 33016-37799) | Jun 8, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | listed, no stance (range 33016-33999) | Jul 23, 2026 | payer document |
| Aetna | Nitric Oxide, Inhalational (INO) (0518) | not covered (range 33016-37790) | Jul 2, 2026 | payer document |
| Aetna | Obstructive Sleep Apnea in Adults (0004) | not covered (range 33202-33249) | Oct 6, 2026 | payer document |
| Aetna | Procalcitonin (PCT) (0771) | listed, no stance (range 33016-33997) | Nov 13, 2025 | payer document |
| Aetna | Stereolithographic Models and Implants (0613) | listed, no stance (range 33010-37790) | Sep 3, 2026 | payer document |
| Blue Shield of California | Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure (2.02.10) | listed, no stance | payer document | |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Biventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure (MED202.054) CPT Codes 33202, 33203, 33207, 33208, 33211, 33213, 33214, 33217, 33220, | listed, no stance | Oct 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.