33235 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 33235

17 of 24 payer prior-auth lists that name 33235 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, CarePlus Health Plans, Humana, Molina Healthcare of Ohio.

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)
CarePlus Health PlansCarePlus Health PlansFLprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaCardiology ServicesAllprior auth requiredHumana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
HumanaCardiology ServicesAllprior auth requiredHumana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
HumanaCardiology ServicesAllprior auth requiredHumana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
HumanaHumana D-SNP (FL)FLprior auth requiredJan 1, 20271 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
HumanaHumana D-SNP (IL)ILprior auth requiredJan 1, 2027Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
HumanaHumana D-SNP (IN)INprior auth requiredJan 1, 2027*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
HumanaHumana D-SNP (MI)MIprior auth requiredJan 1, 20271 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
HumanaHumana D-SNP (SC)SCprior auth requiredJan 1, 2027Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
HumanaHumana D-SNP (VA)VAprior auth requiredJan 1, 2027Virginia Prior Authorization and Notification List
HumanaHumana Healthy HorizonsINprior auth requiredJan 1, 20271 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a
HumanaHumana MA and D-SNPAllprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaHumana Puerto Rico MA and Dual Medicare-MedicaidPRprior auth requiredNov 3, 2025Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Molina Healthcare of OhioMedicaid and MyCare Ohio (MMP) MedicaidOHprior auth under conditionsno PA under 18Oct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of OhioExchangeOHprior auth under conditionsno PA under 18Oct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01

Payer coverage policies that name 33235

33235 appears in 15 coverage policies from Aetna, Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT).

PayerPolicyRole in policyReviewedDocument
AetnaAnesthetic and Antiemetic Infusion Pumps (0607)listed, no stance (range 33016-37799)Sep 9, 2026payer document
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 33010-37799)Jul 30, 2026payer document
AetnaCardiovascular Ultrafiltration (0741)listed, no stance (range 33010-37790)Oct 30, 2025payer document
AetnaCryoanalgesia and Therapeutic Cold (0297)listed, no stance (range 33016-33999)Apr 14, 2026payer document
AetnaFunctional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677)listed, no stance (range 33016-33999)Sep 10, 2026payer document
AetnaInpatient Admission Prior to Surgery (Preop Days) (0255)listed, no stance (range 33016-33980)May 13, 2026payer document
AetnaIntravenous Iron Therapy (0575)listed, no stance (range 33016-33999)Jul 1, 2026payer document
AetnaNegative Pressure Wound Therapy (0334)listed, no stance (range 33016-37799)Jun 8, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 33016-33999)Jul 23, 2026payer document
AetnaNitric Oxide, Inhalational (INO) (0518)not covered (range 33016-37790)Jul 2, 2026payer document
AetnaObstructive Sleep Apnea in Adults (0004)not covered (range 33202-33249)Oct 6, 2026payer document
AetnaProcalcitonin (PCT) (0771)listed, no stance (range 33016-33997)Nov 13, 2025payer document
AetnaStereolithographic Models and Implants (0613)listed, no stance (range 33010-37790)Sep 3, 2026payer document
Blue Shield of CaliforniaBiventricular Pacemakers (Cardiac Resynchronization Therapy) for the Treatment of Heart Failure (2.02.10)listed, no stancepayer 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 stanceOct 1, 2026payer document

Recent prior-auth changes

  • Jan 1, 2026: PA removed, Molina Healthcare of Michigan
  • Jan 1, 2026: PA removed, Molina Healthcare of Illinois
  • Jul 1, 2024: conditions changed, Molina Healthcare of Illinois
  • Jan 1, 2024: PA added, Molina Healthcare of Michigan

Medicaid fee-for-service

  • AZ: $1596.88 (asc), effective Oct 1, 2026
  • CO: $499.25 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $441.61 (physician, non-facility), effective Jan 1, 2026
  • IL: $436.63 (practitioner), effective Apr 1, 2024
  • IN: $471.91 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $350.00 (asc, facility), effective Jan 1, 1994
  • KY: $2042.30 (asc), effective Jan 1, 2026
  • LA: $522.52 (professional), effective Feb 1, 2013
  • MA: $1658.81 (asc), effective May 1, 2026
  • MS: $1563.06 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1203.94 (physician, facility), effective Aug 1, 2026
  • NE: $1637.60 (physician, non-facility), effective Jul 1, 2026
  • NY: $329.89 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $385.14 (physician), effective Jan 1, 2024
  • OK: $1863.23 (asc), effective Jan 1, 2026
  • TX: $1870.58 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $491.90 (medical), effective Jul 1, 2026
  • VT: $2901.60 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1652.62 (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.