51100 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 51100

1 of 1 payer prior-auth lists that name 51100 require prior authorization or set conditions: Humana.

PayerPlanStatePrior authConditionsSinceSource
HumanaHumana Puerto Rico MA and Dual Medicare-MedicaidPRprior auth requiredNov 3, 2025Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification

Payer coverage policies that name 51100

51100 appears in 1 coverage policy from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 50010-53899)Jul 30, 2026payer document

Medicaid fee-for-service

  • AZ: $25.34 (asc), effective Oct 1, 2026
  • CO: $45.29 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $26.66 (physician, facility), effective Jan 1, 2026
  • IL: $26.89 (practitioner), effective Apr 1, 2024
  • IN: $29.88 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $20.37 (asc, facility), effective Jan 1, 2008
  • KY: $45.22 (asc), effective Jan 1, 2026
  • LA: $58.25 (professional), effective Jul 1, 2025
  • MA: $33.13 (asc), effective May 1, 2026
  • MS: $34.16 (comprehensive, facility), effective Oct 1, 2025
  • ND: $44.73 (physician, facility), effective Aug 1, 2026
  • NE: $33.75 (physician, facility), effective Jul 1, 2026
  • NY: $20.20 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $25.61 (physician, facility), effective Jan 1, 2024
  • OK: $41.25 (asc), effective Jan 1, 2026
  • TX: $36.54 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $29.22 (medical, facility), effective Jul 1, 2026
  • VT: $194.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $19.49 (physician, facility), effective Jul 1, 2026
  • WY: $110.49 (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.