51101 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 51101

1 of 1 payer prior-auth lists that name 51101 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 51101

51101 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: $65.20 (asc), effective Oct 1, 2026
  • CO: $125.93 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $34.93 (physician, facility), effective Jan 1, 2026
  • IL: $35.02 (practitioner), effective Apr 1, 2024
  • IN: $39.16 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $27.87 (asc, facility), effective Jan 1, 2008
  • KY: $116.32 (asc), effective Jan 1, 2026
  • LA: $118.97 (professional), effective Jul 1, 2025
  • MA: $89.57 (asc), effective May 1, 2026
  • MS: $86.94 (comprehensive, facility), effective Oct 1, 2025
  • ND: $115.06 (physician, facility), effective Aug 1, 2026
  • NE: $28.40 (physician, facility), effective Jul 1, 2026
  • NY: $26.49 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $36.45 (physician, facility), effective Dec 31, 2013
  • OK: $106.12 (asc), effective Jan 1, 2026
  • TX: $98.83 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $38.48 (medical, facility), effective Jul 1, 2026
  • VT: $666.78 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $25.80 (physician, facility), effective Jul 1, 2026
  • WY: $379.77 (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.