37790 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 37790

2 of 2 payer prior-auth lists that name 37790 require prior authorization or set conditions: Rocky Mountain Health Plans, UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
Rocky Mountain Health PlansRocky Mountain Medicare Advantage D-SNPCOprior auth requiredFeb 1, 2025Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of New YorkNYprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026

Payer coverage policies that name 37790

37790 appears in 7 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
AetnaErectile Dysfunction and Peyronie's Disease (0007)not coveredJul 29, 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
AetnaStereolithographic Models and Implants (0613)listed, no stance (range 33010-37790)Sep 3, 2026payer document

Recent prior-auth changes

  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans

Medicaid fee-for-service

Prior authorization required or conditional in CO, NY, WY.

  • AZ: $1171.31 (asc), effective Oct 1, 2026
  • CO: $356.53 (chp_plus, non-facility), effective Jul 1, 2026
  • IN: $376.58 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KY: $1681.93 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $1170.42 (asc), effective May 1, 2026
  • MS: $1324.25 (comprehensive, facility), effective Oct 1, 2025
  • ND: $991.50 (physician, facility), effective Aug 1, 2026
  • NE: $637.00 (asc), effective Jul 1, 2024
  • NY: $253.50 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $378.81 (physician), effective Jan 1, 2000
  • OK: $1534.46 (asc), effective Jan 1, 2026
  • VA: $383.10 (medical), effective Jul 1, 2026
  • VT: $2737.01 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1558.88 (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.