37290 CPT® code: payer coverage and prior authorization34 of 34 payer prior-auth lists that name 37290 require prior authorization or set conditions: Aetna, CarePlus Health Plans, Cigna, Humana, Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Neighborhood Health Partnership, Oxford Health Plans, Passport by Molina Healthcare (Kentucky), Surest, UnitedHealthcare.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| 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® |
| 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® |
| 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 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 Healthy Horizons | IN | prior auth required | Jan 1, 2027 | 1 Humana Healthy Horizons® in Indiana Preauthorization and Notification List (PAL) for Indiana PathWays for Aging Please note the term prior authorization when used in this communication, is defined a | |
| 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 | |
| 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 Illinois | Medicaid | IL | prior auth required | Jan 1, 2026 | Molina Healthcare of Illinois Codification Grid Q3 2026 | |
| 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 Michigan | Medicare Advantage | MI | prior auth required | adults via Evolent | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 |
| Passport by Molina Healthcare (Kentucky) | Medicaid | KY | prior auth required | adults via Evolent | Jan 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 under conditions | PA not required with dx E08.52, E09.52, E10.52, E11.52, E13.52, I70.221 (+283 more) | 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 | |
| Surest | Surest health plans | All | prior auth under conditions | *Prior authorization for these codes is not required with the following Dx. | 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 under conditions | PA not required with dx E08.52, E09.52, E10.52, E11.52, E13.52, I70.221 (+289 more) | 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 under conditions | PA not required with dx E08.52, E09.52, E10.52, E11.52, E13.52, I70.221 (+283 more) | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth under conditions | *Prior authorization is not required for these diagnosis codes. | 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 under conditions | PA not required with dx E08.52, E09.52, E10.52, E11.52, E13.52, I70.221 (+283 more); 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 under conditions | PA not required with dx E08.52, E09.52, E10.52, E11.52, E13.52, I70.221 (+283 more) | 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 under conditions | PA not required with dx E08.52, E09.52, E10.52, E11.52, E13.52, I70.221 (+283 more) | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026 |
37290 appears in 22 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), 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 | |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Percutaneous Revascularization Procedures for Lower Extremity Peripheral Arterial Disease (SUR707.034) CPT Codes 37254, 37255, 37256, 37257, 37258, 37259, 37260, 37261, 37262, 37263, | listed, no stance | Jan 1, 2026 | payer document |
| Premera Blue Cross | Percutaneous Revascularization Procedures for Lower Extremity Peripheral Arterial Disease (7.01.594) Page | 11 of 33 | ∞ | listed, no stance | Sep 8, 2026 | payer document |
| UnitedHealthcare | Cardiovascular Diagnostic and Therapeutic Procedures (MMP013.22) Lower Extremity Endovascular Revascularization Procedures (e.g., Stenting, Atherectomy, and/or Angioplasty) | listed, no stance | Sep 1, 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.