Payer policies › CPT 4517245172 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 45172 2 of 2 payer prior-auth lists that name 45172 require prior authorization or set conditions: Neighborhood Health Partnership, UnitedHealthcare.
Payer Plan State Prior auth Conditions Since Source Neighborhood Health Partnership Neighborhood Health Partnership FL prior auth under conditions site of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WI Sep 1, 2026 Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 UnitedHealthcare UnitedHealthcare Complete (Individual & Family plans) All prior auth under conditions site of care: outpatient hospital Sep 1, 2026 Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
Payer coverage policies that name 45172 45172 appears in 2 coverage policies from Aetna, Regence.
Payer Policy Role in policy Reviewed Document Aetna Urological Supplies (0533) listed, no stance (range 45000-45999) Jul 30, 2026 payer document Regence Surgical Site of Care – Hospital Outpatient (Utilization Management 19) listed, no stance May 1, 2026 payer document
Recent prior-auth changes Oct 1, 2026: PA removed, Oxford Health Plans Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Community Plan Aug 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, Neighborhood Health Partnership Medicaid fee-for-service AZ: $913.45 (asc), effective Oct 1, 2026 CO: $658.36 (chp_plus, non-facility), effective Jul 1, 2026 FL: $618.25 (physician, non-facility), effective Jan 1, 2026 IL: $564.95 (practitioner), effective Apr 1, 2024 IN: $630.88 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $624.16 (asc, facility), effective Jan 1, 2010 KY: $1398.34 (asc), effective Jan 1, 2026 LA: $665.88 (professional), effective Feb 1, 2013 MA: $935.17 (asc), effective May 1, 2026 MS: $1118.38 (comprehensive, facility), effective Oct 1, 2025 ND: $824.33 (physician, facility), effective Aug 1, 2026 NE: $785.00 (asc), effective Jul 1, 2024 NY: $324.55 (physician_surgery, facility), effective Jul 1, 2026 OH: $472.31 (physician), effective Jan 1, 2024 OK: $1275.74 (asc), effective Jan 1, 2026 TX: $939.93 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $688.66 (medical), effective Jul 1, 2026 VT: $2155.19 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $339.40 (asc), effective Jul 1, 2026 WY: $1227.50 (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.