49321 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 49321

Payer coverage policies that name 49321

49321 appears in 3 coverage policies from Aetna, Cigna.

PayerPolicyRole in policyReviewedDocument
AetnaInfertility (0327)covered if criteria are metJul 16, 2026payer document
AetnaUltrasound Guidance – Selected Indications (0952)covered if criteria are metApr 27, 2026payer document
CignaInfertility Services (0089)covered if criteria are metJun 15, 2025payer document

Medicaid fee-for-service

Prior authorization required or conditional in WV.

  • AZ: $1984.28 (asc), effective Oct 1, 2026
  • CO: $273.03 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $256.13 (physician, non-facility), effective Jan 1, 2026
  • IL: $302.40 (practitioner), effective Jul 1, 2026
  • IN: $262.04 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $435.00 (asc, facility), effective Jan 1, 2000
  • KY: $2958.68 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $1864.96 (asc), effective May 1, 2026
  • MS: $2288.26 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1744.14 (physician, facility), effective Aug 1, 2026
  • NE: $1000.00 (asc), effective Jul 1, 2024
  • NY: $159.73 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $272.11 (physician), effective Jan 1, 2000
  • OK: $2699.27 (asc), effective Jan 1, 2026
  • TX: $1888.85 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $285.30 (medical), effective Jul 1, 2026
  • VT: $4694.12 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $366.60 (asc), effective Jul 1, 2026
  • WY: $2673.55 (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.