37236 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 37236

22 of 29 payer prior-auth lists that name 37236 require prior authorization or set conditions: CarePlus Health Plans, HealthSpring, Humana, Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Molina Healthcare of Ohio, Molina Healthcare of Texas.

PayerPlanStatePrior authConditionsSinceSource
HealthSpringMedicare AdvantageAllprior auth requiredJan 1, 20252026 Q4 Prior Authorization List
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 HorizonsILprior auth requiredJan 1, 2027Humana Healthy Horizons in Illinois Prior Authorization and Notification List To view -specific medical coverage policies, please visit Humana Healthy Horizons in Illinois Clinical coverage policies .
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 CaliforniaMedicaidCAprior auth requiredApr 1, 2026Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of IllinoisMedicaidILprior auth requiredApr 1, 2023Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of MichiganMedicare AdvantageMIprior auth requiredadults via EvolentJul 1, 2026Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of MichiganMedicaidMIprior auth under conditionsadults via Evolent; no PA for pediatricsJul 1, 2026Molina Healthcare of Michigan PA Matrix 2026-Q3
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
Molina Healthcare of TexasExchangeTXprior auth requiredJan 1, 2021Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026

Payer coverage policies that name 37236

37236 appears in 13 coverage policies from Aetna.

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
AetnaDrug-Eluting Stents (0621)listed, no stance (range 37236-37237)Sep 23, 2026payer document
AetnaEndovascular Arterial and Venous Stent Procedures (0785)covered if criteria are metJun 5, 2026payer document
AetnaGrid Monitoring and Intraoperative Electroencephalography (0289)listed, no stance (range 37236-37237)Apr 17, 2026payer document
AetnaIntraoperative Neurophysiological Monitoring (0697)covered if criteria are met (range 37215-37237)Jun 19, 2026payer document
AetnaIntravascular Ultrasound (0382)listed, no stanceMay 26, 2026payer document
AetnaMedian Arcuate Ligament Syndrome: Treatment (1092)covered if criteria are metJan 12, 2026payer document
AetnaNegative Pressure Wound Therapy (0334)listed, no stance (range 33016-37799)Jun 8, 2026payer document
AetnaNitric Oxide, Inhalational (INO) (0518)not covered (range 33016-37790)Jul 2, 2026payer document
AetnaPeripheral Atherectomy and Thrombectomy Devices (0295)covered if criteria are met (range 37220-37247)Apr 16, 2026payer document
AetnaStereolithographic Models and Implants (0613)listed, no stance (range 33010-37790)Sep 3, 2026payer document

Recent prior-auth changes

  • Jan 1, 2026: PA added, Molina Healthcare of Michigan
  • Jul 1, 2025: PA removed, Humana
  • Jul 1, 2024: conditions changed, Molina Healthcare of Illinois
  • Jan 1, 2024: PA added, humana:pa:commercial
  • Jan 1, 2024: PA added, Molina Healthcare of Michigan

Medicaid fee-for-service

  • AZ: $6239.44 (asc), effective Oct 1, 2026
  • CO: $463.93 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $303.41 (physician, facility), effective Jan 1, 2026
  • IL: $306.59 (practitioner), effective Apr 1, 2024
  • IN: $322.20 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $3106.65 (asc, facility), effective Jan 1, 2014
  • KY: $7352.49 (asc), effective Jan 1, 2026
  • LA: $2210.51 (professional), effective Jan 1, 2014
  • MA: $5053.41 (asc), effective May 1, 2026
  • MS: $5619.58 (comprehensive, facility), effective Oct 1, 2025
  • ND: $4334.30 (physician, facility), effective Aug 1, 2026
  • NE: $815.10 (physician, non-facility), effective Jul 1, 2026
  • NY: $257.19 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $365.33 (physician, facility), effective Jan 1, 2024
  • OK: $347.59 (physician, facility), effective Jul 1, 2026
  • TX: $5004.56 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $337.96 (medical, facility), effective Jul 1, 2026
  • VT: $8963.61 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $563.90 (asc), effective Jul 1, 2026
  • WY: $5105.26 (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.