37255 CPT® code: payer coverage and prior authorization11 of 11 payer prior-auth lists that name 37255 require prior authorization or set conditions: Aetna, Cigna, Humana.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Aetna | Medicare Advantage | All | prior auth required | Not required for Student Health, Allina Health | Aetna or federal (FSBP, MHBP, RCBP) plans | Oct 1, 2026 | Participating provider precertification list for Aetna® |
| Aetna | Commercial | All | prior auth required | Not required for Student Health, Allina Health | Aetna or federal (FSBP, MHBP, RCBP) plans | Oct 1, 2026 | Participating provider precertification list for Aetna® |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2026 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2026 | Master Precertification List (For Health Care Providers) |
| Cigna | Vascular Interventions | All | prior auth under conditions | Add-on code: requested with the primary procedure | Mar 7, 2026 | Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs |
| Cigna | Vascular Interventions | All | prior auth under conditions | Add-on code: requested with the primary procedure | Mar 7, 2026 | Cigna Vascular Interventions Commercial Code List (title from file name) |
| 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 (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 | New PA requirement | Jan 1, 2027 | Virginia Prior Authorization and Notification List |
| Humana | Humana MA and D-SNP | All | prior auth required | New PA requirement | Jan 1, 2027 | Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List |
37255 appears in 20 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Premera Blue Cross, 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 | 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 37254-37299) | Apr 16, 2026 | payer document |
| Aetna | Stereolithographic Models and Implants (0613) | listed, no stance (range 33010-37790) | Sep 3, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Percutaneous Revascularization Procedures For Lower Extremity Peripheral Arterial Disease (A.7.01.178) | listed, no stance | payer document | |
| Premera Blue Cross | Percutaneous Revascularization Procedures for Lower Extremity Peripheral Arterial Disease (7.01.594) Page | 5 of 33 | ∞ | listed, no stance | Sep 8, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Endovascular Procedures (CS166.P) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Endovascular Procedures (2026T0602S) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Endovascular Procedures (for Kansas Only) (CS166KS.03) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Endovascular Procedures (for Kentucky Only) (CS166KY.12) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Endovascular Procedures (for Nebraska Only) (CS166NE.P) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Endovascular Procedures (for New Jersey Only) (CS166NJ.M) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Endovascular Procedures (for New Mexico Only) (CS166NM.D) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Endovascular Procedures (for North Carolina Only) (CSNCT0602.05) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Endovascular Procedures (for Ohio Only) (CS166OH.D) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Endovascular Procedures (for Pennsylvania Only) (CS166PA.N) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Lower Extremity Endovascular Procedures (for Tennessee Only) (CS166TN.O) | listed, no stance | Jun 1, 2026 | payer document |
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.