51575 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 51575

1 of 1 payer prior-auth lists that name 51575 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 51575

51575 appears in 4 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaAtezolizumab (Tecentriq) and Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza) (0909)listed, no stanceSep 28, 2026payer document
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 50010-53899)Jul 30, 2026payer document
AetnaDurvalumab (Imfinzi) (0917)listed, no stanceSep 25, 2026payer document
AetnaPharmacogenetic and Pharmacodynamic Testing (0715)listed, no stance (range 51550-51596)Oct 8, 2026payer document

Medicaid fee-for-service

  • AZ: $1852.48 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $1234.61 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $1251.58 (physician, non-facility), effective Jan 1, 2026
  • IL: $1238.82 (practitioner), effective Apr 1, 2024
  • IN: $1395.87 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $704.57 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $1487.65 (physician, facility), effective Jan 1, 2026
  • LA: $1558.17 (professional), effective Feb 1, 2013
  • MA: $1323.90 (physician_surgery), effective May 1, 2024
  • MS: $1370.32 (comprehensive), effective Jul 1, 2026
  • ND: $1713.75 (physician), effective Aug 1, 2026
  • NE: $554.84 (physician, non-facility), effective Jul 1, 2026
  • NY: $919.94 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $1443.29 (physician), effective Jan 1, 2024
  • OK: $1441.53 (physician, non-facility), effective Jul 1, 2026
  • TX: $189.58 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026
  • VA: $1394.10 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $938.87 (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.