47125 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 47125

2 of 2 payer prior-auth lists that name 47125 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, HealthSpring.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross and Blue Shield of IllinoisBlue Cross Community MMAI (Medicare-Medicaid Alignment Initiative)ILprior auth requiredJan 1, 2025Procedure Code List, Effective 1/1/2025
HealthSpringMedicare AdvantageAllprior auth requiredJan 1, 20252026 Q4 Prior Authorization List

Payer coverage policies that name 47125

47125 appears in 2 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaLiver Transplantation (0596)listed, no stance (range 47120-47130)Sep 8, 2026payer document
AetnaLiver and Other Neoplasms - Treatment Approaches (0268)listed, no stanceSep 18, 2026payer document

Recent prior-auth changes

  • Apr 1, 2026: PA removed, Blue Cross and Blue Shield of Illinois
  • Apr 1, 2026: PA removed, Blue Cross and Blue Shield of Illinois

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • AZ: $3130.01 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $1459.12 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $3076.02 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IL: $2171.67 (practitioner), effective Apr 1, 2024
  • IN: $2295.99 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $1880.16 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $1396.80 (physician, facility), effective Jan 1, 2026
  • LA: $2507.59 (professional), effective Jul 1, 2025
  • MA: $2241.32 (physician_surgery), effective May 1, 2024
  • MS: $2357.08 (comprehensive), effective Jul 1, 2026
  • ND: $2881.53 (physician), effective Aug 1, 2026
  • NE: $3327.08 (physician, non-facility), effective Jul 1, 2026
  • NY: $1411.10 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $1705.99 (physician), effective Jan 1, 2024
  • OK: $2488.09 (physician, non-facility), effective Jul 1, 2026
  • TX: $332.96 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026
  • VA: $2448.50 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $1623.59 (physician, facility), effective Jul 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.