45398 CPT® code: payer coverage and prior authorization3 of 3 payer prior-auth lists that name 45398 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Neighborhood Health Partnership, UnitedHealthcare.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | Standard PA code list (most commercial plans) | AZ | prior auth under conditions | place of service 19, 21, 22; site of care: hospital (not ASC) | Sep 1, 2026 | AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026) |
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth required | site of care: site of service reviewed | 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 |
45398 appears in 6 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Centene, Regence.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Colonoscopy, Colorectal Cancer Screening, and Related Procedures (0516) | covered if criteria are met | Aug 20, 2026 | payer document |
| Aetna | Exhaled Breath Tests (0691) | listed, no stance (range 45378-45398) | Oct 16, 2025 | payer document |
| Aetna | Urological Supplies (0533) | listed, no stance (range 45000-45999) | Jul 30, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Colonoscopy Flexible Sigmoidoscopy And Ct Colonography (L.2.04.403) | covered if criteria are met | payer document | |
| Centene | Anesthesiology Services for Gastrointestinal Endoscopy (CP.MP.161) | covered if criteria are met | May 1, 2019 | payer document |
| Regence | Surgical Site of Care – Colonoscopy and Sigmoidoscopy (Utilization Management 20) | listed, no stance | Feb 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.