45380 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 45380

22 of 22 payer prior-auth lists that name 45380 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Humana, Neighborhood Health Partnership, UnitedHealthcare, UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)Standard PA code list (most commercial plans)AZprior auth under conditionsplace of service 19, 21, 22; site of care: hospital (not ASC)Sep 1, 2026AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026)
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Neighborhood Health PartnershipNeighborhood Health PartnershipFLprior auth requiredsite of care: site of service reviewedSep 1, 2026Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth under conditionssite of care: outpatient hospitalSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcare Community PlanAHCCCS Complete Care (ACC)AZprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026
UnitedHealthcare Community PlanALTCS Developmentally DisabledAZprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026
UnitedHealthcare Community PlanMaryland HealthChoiceMDprior auth under conditionssite of care: outpatient hospitalSep 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community PlanMassachusetts Senior Care Options (SCO) and OneCareMAprior auth requiredOct 1, 2026Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026
UnitedHealthcare Community PlanMississippi CHIPMSprior auth under conditionssite of care: outpatient hospitalApr 1, 2025Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community PlanMississippiCANMSprior auth under conditionssite of care: outpatient hospitalApr 1, 2025Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025
UnitedHealthcare Community PlanMissouri MedicaidMOprior auth under conditionssite of care: outpatient hospitalJul 1, 2026Prior authorization requirements for Missouri Medicaid Effective July 1, 2026
UnitedHealthcare Community PlanOhio MedicaidOHprior auth under conditionssite of care: outpatient hospital, ASCNov 1, 2025Prior authorization requirements for Ohio Medicaid Effective November 1, 2025 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community Plan
UnitedHealthcare Community PlanPennsylvania CHIPPAprior auth under conditionssite of care: outpatient hospitalJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026
UnitedHealthcare Community PlanPennsylvania MedicaidPAprior auth under conditionssite of care: outpatient hospitalJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026
UnitedHealthcare Community PlanRhode Island MedicaidRIprior auth under conditionssite of care: outpatient hospitalMay 1, 2026Prior 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 PlanTennCareTNprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Tennessee Effective October 1, 2026
UnitedHealthcare Community PlanTexas CHIPTXprior auth under conditionssite of care: outpatient hospitalJul 1, 2020Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care
UnitedHealthcare Community PlanTexas STARTXprior auth under conditionssite of care: outpatient hospitalJul 1, 2020Prior authorization requirements for Texas STAR Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR h
UnitedHealthcare Community PlanTexas STAR KidsTXprior auth under conditionssite of care: outpatient hospitalJul 1, 2020Prior authorization requirements for STAR Kids Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR Ki
UnitedHealthcare Community PlanTexas STAR+PLUSTXprior auth under conditionssite of care: outpatient hospitalJul 1, 2020Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of New YorkNYprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026
UnitedHealthcare Community PlanWashington Apple HealthWAprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior authorization requirements for the UnitedHealthcare Community Plan of Washington Effective April 1, 2023

Payer coverage policies that name 45380

45380 appears in 12 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, Centene, Premera Blue Cross, Regence, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaCapsule Endoscopy (0588)listed, no stanceSep 15, 2026payer document
AetnaColonoscopy, Colorectal Cancer Screening, and Related Procedures (0516)covered if criteria are metAug 20, 2026payer document
AetnaColonoscopy, Colorectal Cancer Screening, and Related Procedures (0516)covered if criteria are met (range 45378-45393)Aug 20, 2026payer document
AetnaExhaled Breath Tests (0691)listed, no stance (range 45378-45398)Oct 16, 2025payer document
AetnaRisankizumab-rzaa (Skyrizi) (1009)listed, no stance (range 45300-45393)Jul 1, 2026payer document
AetnaUrological Supplies (0533)listed, no stance (range 45000-45999)Jul 30, 2026payer document
AnthemColonoscopy (CG-SURG-01)covered if criteria are metAug 13, 2026payer document
Blue Cross & Blue Shield of MississippiColonoscopy Flexible Sigmoidoscopy And Ct Colonography (L.2.04.403)covered if criteria are metpayer document
Blue Shield of CaliforniaBSC10.01 Place of Service Policy for Outpatient Procedureslisted, no stancepayer document
CenteneAnesthesiology Services for Gastrointestinal Endoscopy (CP.MP.161)covered if criteria are metMay 1, 2019payer document
Premera Blue CrossPreventive Carecovered if criteria are metSep 21, 2026payer document
RegenceSurgical Site of Care – Colonoscopy and Sigmoidoscopy (Utilization Management 20)listed, no stanceFeb 1, 2026payer document
UnitedHealthcareScreening Colonoscopy Procedures – Site of Service (MP.15.14)listed, no stanceJul 1, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, Oxford Health Plans
  • Oct 1, 2026: PA removed, UnitedHealthcare Community Plan
  • Oct 1, 2026: PA removed, UnitedHealthcare Community Plan
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, UnitedHealthcare Community Plan
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: conditions changed, UnitedHealthcare Community Plan
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Aug 1, 2026: conditions changed, UnitedHealthcare

Medicaid fee-for-service

  • AZ: $383.41 (asc), effective Oct 1, 2026
  • CO: $254.41 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $138.20 (physician, facility), effective Jan 1, 2026
  • IL: $193.80 (practitioner), effective Apr 1, 2024
  • IN: $153.08 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $225.00 (asc, facility), effective Aug 1, 1982
  • KY: $641.09 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $431.31 (asc), effective May 1, 2026
  • MS: $506.37 (comprehensive, facility), effective Oct 1, 2025
  • ND: $377.92 (physician, facility), effective Aug 1, 2026
  • NE: $413.00 (asc), effective Jul 1, 2024
  • NY: $161.60 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $202.79 (physician, facility), effective Jan 1, 2024
  • OK: $584.88 (asc), effective Jan 1, 2026
  • TX: $429.26 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $153.94 (medical, facility), effective Jul 1, 2026
  • VT: $929.15 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $308.28 (asc), effective Jul 1, 2026
  • WY: $529.20 (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.