`37243` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 37243

92 of 92 payer prior-auth lists that name 37243 require prior authorization or set conditions: CarePlus Health Plans, Cigna, Humana, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of South Carolina, Molina Healthcare of Texas, Molina Healthcare of Utah, Molina Healthcare of Washington, Molina Healthcare of Wisconsin, and others.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Cigna	ACA/IFP	All	prior auth required	May be delegated to eviCore for some clients	Nov 1, 2024	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required	May be delegated to eviCore for some clients	Nov 1, 2024	Master Precertification List (For Health Care Providers)
Cigna	Vascular Interventions	All	prior auth required		Mar 7, 2026	Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
Cigna	Vascular Interventions	All	prior auth required		Mar 7, 2026	Cigna Vascular Interventions Commercial Code List (title from file name)
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth required		Jan 1, 2027	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Humana	Cardiology Services	All	prior auth required			Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
Humana	Cardiology Services	All	prior auth required			Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
Humana	Cardiology Services	All	prior auth required			Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
Humana	Humana D-SNP (FL)	FL	prior auth required		Jan 1, 2027	1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
Humana	Humana D-SNP (IL)	IL	prior auth required		Jan 1, 2027	Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
Humana	Humana D-SNP (IN)	IN	prior auth required		Jan 1, 2027	*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
Humana	Humana D-SNP (MI)	MI	prior auth required		Jan 1, 2027	1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
Humana	Humana D-SNP (SC)	SC	prior auth required		Jan 1, 2027	Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
Humana	Humana D-SNP (VA)	VA	prior auth required		Jan 1, 2027	Virginia Prior Authorization and Notification List
Humana	Humana Healthy Horizons	IL	prior auth required		Jan 1, 2027	Humana 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 .
Humana	Humana MA and D-SNP	All	prior auth required		Jan 1, 2027	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Humana	Oak Street Health	All	prior auth required			Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Molina Complete Care (Virginia)	Medicare-only PA matrix for D-SNP	VA	prior auth required		Jan 1, 2022	Medicare Prior Auth (PA) Code Matrix (Virginia), effective Q1 2022
Molina Complete Care (Virginia)	Medicaid	VA	prior auth required		Apr 1, 2025	Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
Molina Healthcare of Arizona	Medicare-only PA matrix for D-SNP	AZ	prior auth required		Jan 1, 2022	Medicare Prior Auth (PA) Code Matrix (Arizona), effective Q1 2022
Molina Healthcare of California	Medicare Advantage	CA	prior auth required		Jul 1, 2021	Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021
Molina Healthcare of California	Medicaid	CA	prior auth required		Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of Florida	Medicare Advantage	FL	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021
Molina Healthcare of Idaho	Medicare Advantage	ID	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021
Molina Healthcare of Idaho	Medicaid	ID	prior auth required		Jan 1, 2025	Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
Molina Healthcare of Illinois	Medicaid	IL	prior auth required		Apr 1, 2023	Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of Iowa	Medicaid	IA	prior auth required		Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023
Molina Healthcare of Michigan	Exchange	MI	prior auth required		Jul 1, 2021	Molina Healthcare of Michigan PA Matrix, effective 7/1/2021
Molina Healthcare of Michigan	Medicare Advantage	MI	prior auth required	adults via Evolent	Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Michigan	Medicaid	MI	prior auth required	adults via Evolent	Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Mississippi	Medicaid	MS	prior auth required	adults via Evolent	Jan 1, 2025	Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
Molina Healthcare of Nevada	Medicaid	NV	prior auth required	adults via NCH	Oct 1, 2022	Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022
Molina Healthcare of New Mexico	Medicare Advantage	NM	prior auth required		Jan 1, 2021	Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021
Molina Healthcare of New Mexico	Medicaid	NM	prior auth required		Jul 1, 2026	New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026
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	Medicare and MyCare Ohio (MMP) Medicare	OH	prior auth required		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
Molina Healthcare of South Carolina	Medicare Advantage	SC	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021
Molina Healthcare of Texas	STAR	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19
Molina Healthcare of Texas	STAR+PLUS	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19
Molina Healthcare of Texas	STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix)	TX	prior auth required		Jul 1, 2026	Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3
Molina Healthcare of Texas	Exchange	TX	prior auth required		Sep 1, 2019	Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026
Molina Healthcare of Utah	Medicaid	UT	prior auth required		Jan 1, 2025	Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
Molina Healthcare of Utah	Medicare Advantage	UT	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021
Molina Healthcare of Washington	Medicare Advantage	WA	prior auth required		Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021
Molina Healthcare of Wisconsin	Medicare Advantage	WI	prior auth required		Oct 1, 2021	Medicare Prior Auth (PA) Code Matrix (Wisconsin), effective Q4 2021
Molina Healthcare, Inc. (national grid)	Molina national (MHI) Medicare grid	All	prior auth required		Oct 1, 2021	Medicare Prior Auth (PA) Code Matrix (national), effective Q4 2021
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth required	adults via Evolent	Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
Neighborhood Health Partnership	Neighborhood Health Partnership	FL	prior auth required		Sep 1, 2026	Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Oxford Health Plans	Oxford Health Plans	All	prior auth required		Oct 1, 2026	Prior Authorization Requirements for Oxford Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans CHP+	CO	prior auth required		Oct 1, 2026	Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans Prime / RAE	CO	prior auth required		Oct 1, 2026	Rocky Mountain Health Plans PRIME Effective October 1, 2026
Surest	Surest health plans	All	prior auth required		Oct 1, 2026	Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcare	Preferred Care Network and Preferred Care Partners of Florida	FL	prior auth required		Oct 1, 2026	Prior authorization requirements for Preferred Care Network and Preferred Care Partners of Florida Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Commercial	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Complete (Individual & Family plans)	All	prior auth required		Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcare	UnitedHealthcare Individual Exchange plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Medicare Advantage, Peoples Health and Dual Complete (D-SNP)	All	prior auth required	Excluded plans: Erickson Advantage	Oct 1, 2026	UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Mid-Atlantic Health Plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare West commercial plans	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare of the River Valley	All	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026
UnitedHealthcare Community Plan	AHCCCS Complete Care (ACC)	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Developmentally Disabled	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026
UnitedHealthcare Community Plan	ALTCS Long Term Care	AZ	prior auth required		Oct 1, 2026	Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026
UnitedHealthcare Community Plan	KanCare	KS	prior auth required		Oct 1, 2026	Prior authorization requirements for Kansas Medicaid Effective October 1, 2026
UnitedHealthcare Community Plan	Maryland HealthChoice	MD	prior auth required		Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community Plan	Michigan Medicaid, Healthy Michigan Plan, CSHCS	MI	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Michigan, Healthy Michigan Plan and Children’s Special Health Care Services Effective October 1, 2026
UnitedHealthcare Community Plan	Minnesota Metro Medicaid	MN	prior auth required		Oct 1, 2024	Prior authorization requirements for Minnesota Medicaid Effective October 1, 2024
UnitedHealthcare Community Plan	Mississippi CHIP	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community Plan	MississippiCAN	MS	prior auth required		Apr 1, 2025	Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025
UnitedHealthcare Community Plan	Missouri Medicaid	MO	prior auth required		Jul 1, 2026	Prior authorization requirements for Missouri Medicaid Effective July 1, 2026
UnitedHealthcare Community Plan	Nebraska Heritage Health	NE	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Nebraska Effective July 1, 2026 General Information This list contains prior authorization requirements for participating United
UnitedHealthcare Community Plan	New Jersey FamilyCare	NJ	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U
UnitedHealthcare Community Plan	New Mexico Turquoise Care	NM	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026
UnitedHealthcare Community Plan	North Carolina Medicaid	NC	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of North Carolina Effective October 1, 2026 July 1, 2024
UnitedHealthcare Community Plan	Ohio Medicaid	OH	prior auth required		Nov 1, 2025	Prior authorization requirements for Ohio Medicaid Effective November 1, 2025 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community Plan
UnitedHealthcare Community Plan	Pennsylvania CHIP	PA	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026
UnitedHealthcare Community Plan	Pennsylvania Medicaid	PA	prior auth required		Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026
UnitedHealthcare Community Plan	Rhode Island Medicaid	RI	prior auth required		May 1, 2026	Prior authorization requirements for Rhode Island Medicaid Effective May 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan of Rhode Island h
UnitedHealthcare Community Plan	TennCare	TN	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Tennessee Effective October 1, 2026

Payer coverage policies that name 37243

37243 appears in 75 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, BlueCross BlueShield of South Carolina, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Ablation of Hepatic Lesions (0274)	covered if criteria are met	Jun 8, 2026	payer document
Aetna	Anesthetic and Antiemetic Infusion Pumps (0607)	listed, no stance (range 33016-37799)	Sep 9, 2026	payer document
Aetna	Benign Prostatic Hyperplasia (0079)	covered if criteria are met	Apr 15, 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	Embolization: Selected Procedures (0856)	covered if criteria are met	Jan 12, 2026	payer document
Aetna	Fibroid Treatment (0304)	covered if criteria are met	Apr 17, 2026	payer document
Aetna	Liver and Other Neoplasms - Treatment Approaches (0268)	covered if criteria are met	Sep 18, 2026	payer document
Aetna	Negative Pressure Wound Therapy (0334)	listed, no stance (range 33016-37799)	Jun 8, 2026	payer document
Aetna	Nitric Oxide, Inhalational (INO) (0518)	not covered (range 33016-37790)	Jul 2, 2026	payer document
Aetna	Peripheral Atherectomy and Thrombectomy Devices (0295)	covered if criteria are met (range 37220-37247)	Apr 16, 2026	payer document
Aetna	Stereolithographic Models and Implants (0613)	listed, no stance (range 33010-37790)	Sep 3, 2026	payer document
Aetna	Ultrasound Guidance – Selected Indications (0952)	not covered	Apr 27, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Occlusion Of Uterine Arteries Using Transcatheter Embolization (L.4.01.417)	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Prostate Artery Embolization For Benign Prostatic Hyperplasia	unproven / investigational		payer document
Blue Cross & Blue Shield of Mississippi	Radioembolization For Primary And Metastatic Tumors Of The Liver	covered if criteria are met		payer document
Blue Cross & Blue Shield of Mississippi	Transcatheter Arterial Chemoembolization To Treat Primary Or Metastatic Liver Malignancies	covered if criteria are met		payer document
Blue Cross & Blue Shield of Rhode Island	Miscellaneous Vascular Embolization Procedures	covered if criteria are met	Apr 15, 2026	payer document
Blue Cross Blue Shield of Massachusetts	Transcatheter Arterial Chemoembolization (634)	listed, no stance		payer document
Blue Cross NC	Chemoembolization of the Hepatic Artery, Transcatheter Approach	listed, no stance	May 1, 2026	payer document
Blue Cross NC	Congenital Heart Defect, Repair Devices	listed, no stance	Jun 1, 2026	payer document
Blue Cross NC	Ovarian and Internal Iliac Vein Embolization, Ablation and Sclerotherapy	listed, no stance	Mar 1, 2026	payer document
Blue Cross NC	Radioembolization for Primary and Metastatic Tumors of the Liver	listed, no stance	May 1, 2026	payer document
Blue Shield of California	Prostate Artery Embolization for Benign Prostatic Hyperplasia (7.01.55)	listed, no stance		payer document
BlueCross BlueShield of South Carolina	Occlusion of Uterine Arteries Using Transcatheter Embolization (CAM 40111)	listed, no stance	Aug 1, 2026	payer document
BlueCross BlueShield of South Carolina	Radioembolization for Primary and Metastatic Tumors of the Liver (CAM 80143)	listed, no stance	Oct 1, 2025	payer document
BlueCross BlueShield of South Carolina	Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction Due to Benign Prostatic Hyperplasia (BPH) (CAM 139) 52649 \| Prostate laser enucleation	listed, no stance	Mar 1, 2026	payer document
BlueCross BlueShield of South Carolina	Transcatheter Arterial Chemoembolization To Treat Primary or Metastatic Liver Malignancies (CAM 80111)	listed, no stance	Aug 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Genicular Artery Embolization (SUR705.048)	listed, no stance	Jul 15, 2025	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Prostate Artery Embolization for Benign Prostatic Hyperplasia (SUR710.027)	listed, no stance	Jul 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Radioembolization for Primary and Metastatic Tumors of the Liver (RAD601.047)	listed, no stance	Nov 15, 2025	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies (THE801.022)	listed, no stance	Dec 1, 2025	payer document
Premera Blue Cross	Prostate Artery Embolization for Benign Prostatic Hyperplasia (7.01.55)	listed, no stance	Mar 10, 2026	payer document
Premera Blue Cross	Radioembolization for Primary and Metastatic Tumors of the Liver (8.01.521)	listed, no stance	Sep 7, 2026	payer document
Premera Blue Cross	Transcatheter Arterial Chemoembolization (TACE) to Treat Primary or Metastatic Liver Malignancies (8.01.11)	listed, no stance	Sep 21, 2026	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (2026T0442VV) Uterine Fibroids	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (CS002.AG) Uterine Fibroids	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Idaho Only) (CS002ID.C) Uterine Fibroids	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Kansas Only) (CS002KS.02) Uterine Fibroids	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Kentucky Only) (CS002KY.10) Uterine Fibroids	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Nebraska Only) (CS002NE.AG) Uterine Fibroids	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for New Jersey Only) (CS002NJ.AE) Uterine Fibroids	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for New Mexico Only) (CS002NM.C) Uterine Fibroids	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for North Carolina Only) (CSNCT0442.06) Uterine Fibroids	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Ohio Only) (CS002OH.D) Uterine Fibroids	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Pennsylvania Only) (CS002PA.AE) Uterine Fibroids	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Abnormal Uterine Bleeding and Uterine Fibroids (for Tennessee Only) (CS002TN.AF) Uterine Fibroids	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Prostate Services and Procedures and Impotence Treatment (MMP075.14) Prostate Artery Embolization (PAE) for Benign Prostatic Hyperplasia (BPH) Related Lower Urinary Tract Symptoms (LUTS)	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (CS334.H)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (2026T0618P)	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (for Idaho Only) (CS334ID.C)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (for Kansas Only) (CS334KS.02)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (for Kentucky Only) (CS334KY.12)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (for Nebraska Only) (CS334NE.I)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (for New Jersey Only) (CS334NJ.G)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (for New Mexico Only) (CS334NM.D)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (for North Carolina Only) (CSNCT0705.09)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (for Ohio Only) (CS334OH.E)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (for Pennsylvania Only) (CS334PA.H)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Prostate Surgeries and Interventions (for Tennessee Only) (CS334TN.H)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Radiation and Oncologic Procedures (MMP077.17) Implantable Beta-Emitting Microspheres for Treatment of Malignant Tumors	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060NE.O)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060PA.O)	listed, no stance	Feb 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (2026T0445BB)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060NJ.M)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060NM.C)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060LA.M)	listed, no stance	Mar 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (CS060.O)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/ Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for North Carolina Only) (CSNCT0445.03)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Idaho Only) (CS060ID.B)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Kansas Only) (CS060KS.02)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Kentucky Only) (CS060KY.10)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Ohio Only) (CS060OH.D)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Transarterial Radioembolization (TARE)/Selective Internal Radiation Therapy (SIRT) for the Treatment of Malignant Cancers of the Liver (for Tennessee Only) (CS060TN.N)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	Uterine Services and Procedures (MMP098.11) UAE for Uterine Fibroids	listed, no stance	Sep 1, 2026	payer document

Recent prior-auth changes

Mar 1, 2025: PA added, Rocky Mountain Health Plans
Mar 1, 2025: PA added, Rocky Mountain Health Plans

Medicaid fee-for-service

AZ: $5083.48 (asc), effective Oct 1, 2026
CO: $1562.64 (chp_plus, non-facility), effective Jul 1, 2026
FL: $376.86 (physician, facility), effective Jan 1, 2026
IL: $376.80 (practitioner), effective Apr 1, 2024
IN: $426.02 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
KS: $2486.26 (asc, facility), effective Jan 1, 2019
KY: $5290.19 (asc), effective Jan 1, 2026
LA: $7527.82 (professional), effective Jan 1, 2014
MA: $3555.50 (asc), effective May 1, 2026
MS: $5224.16 (comprehensive, facility), effective Oct 1, 2025
ND: $3118.57 (physician, facility), effective Aug 1, 2026
NE: $1926.60 (physician, non-facility), effective Jul 1, 2026
NY: $326.35 (physician_surgery, facility), effective Jul 1, 2026
OH: $465.38 (physician, facility), effective Jan 1, 2024
OK: $436.87 (physician, facility), effective Jul 1, 2026
TX: $3491.58 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
VA: $417.82 (medical, facility), effective Jul 1, 2026
VT: $8963.61 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $279.01 (physician, facility), 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.

37243 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 37243

Payer coverage policies that name 37243

Recent prior-auth changes

Medicaid fee-for-service

`37243` CPT® code: payer coverage and prior authorization