33280 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 33280

15 of 15 payer prior-auth lists that name 33280 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Shield of California Promise Health Plan, CarePlus Health Plans, Humana.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)AZ Blue-administered Medicare Advantage (M2K)AZprior auth requiredSep 1, 2026AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)Standard PA code list (most commercial plans)AZprior auth requiredSep 1, 2026AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)State of Arizona employee group (SYD, S3Z)AZprior auth requiredSep 1, 2026State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)
Blue Shield of California Promise Health PlanPromise Health Plan Medi-CalCAprior auth requiredSep 1, 2026Medi-Cal Prior Authorization List
CarePlus Health PlansCarePlus Health PlansFLprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
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 HorizonsVAprior auth requiredJan 1, 2027Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
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

Payer coverage policies that name 33280

33280 appears in 31 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, Capital Blue Cross, Regence, UnitedHealthcare.

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)covered if criteria are metSep 10, 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
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
AnthemDiaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems (CG-MED-79)not coveredNov 6, 2025payer document
Blue Cross & Blue Shield of MississippiPhrenic Nerve Stimulation For Central Sleep Apneaunproven / investigationalpayer document
Blue Cross Blue Shield of MassachusettsPhrenic Nerve Stimulation for Central Sleep Apnea (955)unproven / investigationalpayer document
Blue Cross NCPhrenic Nerve Stimulation for Central Sleep Apnealisted, no stanceMar 1, 2026payer document
Blue Shield of CaliforniaPhrenic Nerve Stimulation for Central Sleep Apnea (2.02.33)listed, no stancepayer document
Capital Blue CrossSurgical Treatment of Sleep Apnea and Snoring (MP 1.128)
Procedure codes
unproven / investigationalApr 1, 2026payer document
RegencePhrenic Nerve Stimulation for Central Sleep Apnea (Surgery 212)listed, no stanceJun 1, 2025payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (2026T0525UU)listed, no stanceApr 1, 2026payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (CS116.AM)listed, no stanceJul 1, 2026payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (for Idaho Only) (CS116ID.D)listed, no stanceJul 1, 2026payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (for Kansas Only) (CS116KS.03)listed, no stanceJul 1, 2026payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (for Kentucky Only) (CS116KY.16)listed, no stanceJul 1, 2026payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (for Nebraska Only) (CS116NE.AI)listed, no stanceAug 1, 2026payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (for New Jersey Only) (CS116NJ.AK)listed, no stanceJul 1, 2026payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (for New Mexico Only) (CS116NM.E)listed, no stanceJul 1, 2026payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (for North Carolina Only) (CSNCT0525.12)listed, no stanceAug 1, 2026payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (for Ohio Only) (CS116OH.G)listed, no stanceJul 1, 2026payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (for Pennsylvania Only) (CS116PA.AL)listed, no stanceJul 1, 2026payer document
UnitedHealthcareObstructive and Central Sleep Apnea Treatment (for Tennessee Only) (CS116TN.AN)listed, no stanceJul 1, 2026payer document

Recent prior-auth changes

  • Jan 1, 2027: PA added, Humana
  • Jan 1, 2024: PA added, Blue Shield of California Promise Health Plan
  • Jan 1, 2024: PA added, humana:pa:commercial

Medicaid fee-for-service

  • AZ: $1327.81 (asc), effective Oct 1, 2026
  • CO: $164.71 (health_first_colorado), effective Jul 1, 2026
  • IL: $142.39 (practitioner), effective Jul 1, 2026
  • IN: $159.95 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KY: $1955.63 (asc), effective Jan 1, 2026
  • LA: $171.77 (professional), effective Jan 1, 2024
  • MA: $1613.44 (asc), effective May 1, 2026
  • MS: $1555.46 (comprehensive, facility), effective Oct 1, 2025
  • ND: $0.00 (physician), effective Aug 1, 2026
  • NY: $175.30 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $155.32 (physician), effective Jan 1, 2024
  • OK: $167.95 (physician, non-facility), effective Jul 1, 2026
  • TX: $1518.53 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jan 1, 2024
  • VA: $166.38 (medical, facility), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $1546.11 (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.