33287 CPT® code: payer coverage and prior authorization14 of 14 payer prior-auth lists that name 33287 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), CarePlus Health Plans, Humana.
33287 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.
| 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) | covered if criteria are met | Sep 10, 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 | 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 |
| Anthem | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems (CG-MED-79) | not covered | Nov 6, 2025 | payer document |
| Blue Cross & Blue Shield of Mississippi | Phrenic Nerve Stimulation For Central Sleep Apnea | unproven / investigational | payer document | |
| Blue Cross Blue Shield of Massachusetts | Phrenic Nerve Stimulation for Central Sleep Apnea (955) | unproven / investigational | payer document | |
| Blue Cross NC | Phrenic Nerve Stimulation for Central Sleep Apnea | listed, no stance | Mar 1, 2026 | payer document |
| Blue Shield of California | Phrenic Nerve Stimulation for Central Sleep Apnea (2.02.33) | listed, no stance | payer document | |
| Capital Blue Cross | Surgical Treatment of Sleep Apnea and Snoring (MP 1.128) Procedure codes | unproven / investigational | Apr 1, 2026 | payer document |
| Regence | Phrenic Nerve Stimulation for Central Sleep Apnea (Surgery 212) | listed, no stance | Jun 1, 2025 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (CS116.AM) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (2026T0525UU) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Idaho Only) (CS116ID.D) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Kansas Only) (CS116KS.03) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Kentucky Only) (CS116KY.16) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Nebraska Only) (CS116NE.AI) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for New Jersey Only) (CS116NJ.AK) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for New Mexico Only) (CS116NM.E) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for North Carolina Only) (CSNCT0525.12) | listed, no stance | Aug 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Ohio Only) (CS116OH.G) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Pennsylvania Only) (CS116PA.AL) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Obstructive and Central Sleep Apnea Treatment (for Tennessee Only) (CS116TN.AN) | listed, no stance | Jul 1, 2026 | payer document |
Prior authorization required or conditional in VA.
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.