Payer policies › CPT 4738447384 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 47384 9 of 9 payer prior-auth lists that name 47384 require prior authorization or set conditions: CarePlus Health Plans, Humana.
Payer Plan State Prior auth Conditions Since Source CarePlus Health Plans CarePlus Health Plans FL prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List Humana Humana D-SNP (FL) FL prior auth required Jan 1, 2027 1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List Humana Humana D-SNP (IL) IL prior auth required Jan 1, 2027 Humana Dual Fully Integrated Illinois Prior Authorization and Notification List Humana Humana D-SNP (IN) IN prior auth required Jan 1, 2027 *New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List Humana Humana D-SNP (MI) MI prior auth required Jan 1, 2027 1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List Humana Humana D-SNP (SC) SC prior auth required Jan 1, 2027 Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List Humana Humana D-SNP (VA) VA prior auth required Jan 1, 2027 Virginia Prior Authorization and Notification List Humana Humana Healthy Horizons IL prior auth required Jan 1, 2027 Humana Healthy Horizons in Illinois Prior Authorization and Notification List To view -specific medical coverage policies, please visit Humana Healthy Horizons in Illinois Clinical coverage policies . Humana Humana MA and D-SNP All prior auth required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Payer coverage policies that name 47384 47384 appears in 8 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Capital Blue Cross, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.
Payer Policy Role in policy Reviewed Document Aetna Irreversible Electroporation (NanoKnife) (0828) not covered Mar 3, 2026 payer document Anthem Irreversible Electroporation (SURG.00126) unproven / investigational May 14, 2026 payer document Blue Cross & Blue Shield of Mississippi Irreversible Electroporation Of Tumors Located In The Liver Pancreas Kidney Or Lung unproven / investigational payer document Capital Blue Cross Irreversible Electroporation of Tumors Located in the Liver, Pancreas, Kidney or Lung (MP 1.162)Procedure codes unproven / investigational Mar 1, 2026 payer document Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) Irreversible Electroporation (IRE) (SUR701.048) listed, no stance Jan 1, 2026 payer document Premera Blue Cross Irreversible Electroporation of Tumors Located in the Liver, Pancreas, Kidney, Lung, or Prostate (6.01.68) listed, no stance Feb 3, 2026 payer document Regence Irreversible Electroporation (Surgery 242) listed, no stance Dec 1, 2025 payer document UnitedHealthcare Omnibus Codes (MMP107.09)Palmetto** | no LCDs/LCAs, refer to listed, no stance Jun 1, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in IN.
AZ: $4819.91 (asc), effective Oct 1, 2026 IL: $307.27 (practitioner), effective Jan 1, 2026 KS: $194.35 (default, Exempt Physician), effective Jan 1, 2026 LA: $217.00 (asc), effective Jan 1, 2026 ND: $4378.96 (physician, facility), effective Aug 1, 2026 NY: $226.54 (physician_surgery, facility), effective Jul 1, 2026 OH: $334.55 (code_changes), effective Jan 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WY: $4700.90 (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.