51784 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 51784

Payer coverage policies that name 51784

51784 appears in 5 coverage policies from Aetna, Blue Cross NC, Capital Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 50010-53899)Jul 30, 2026payer document
AetnaIntraoperative Neurophysiological Monitoring (0697)covered if criteria are metJun 19, 2026payer document
AetnaUrinary Incontinence (0223)covered if criteria are metJul 16, 2026payer document
Blue Cross NCIntraoperative Neurophysiologic Monitoringlisted, no stanceMay 1, 2026payer document
Capital Blue CrossElectromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter (MP 2.096)
Procedure codes		covered if criteria are metSep 1, 2026payer document

Medicaid fee-for-service

  • AZ: $15.98 (asc), effective Oct 1, 2026
  • CO: $53.14 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $22.86 (physician), effective Jan 1, 2026
  • IL: $52.70 (practitioner), effective Apr 1, 2021
  • IN: $49.44 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $125.00 (asc, facility), effective Jan 1, 1995
  • KY: $28.50 (asc), effective Jan 1, 2026
  • LA: $134.34 (professional), effective Feb 1, 2013
  • MA: $24.85 (asc), effective May 1, 2026
  • MS: $21.22 (comprehensive, facility), effective Oct 1, 2025
  • ND: $28.20 (physician, facility), effective Aug 1, 2026
  • NE: $185.24 (physician, non-facility), effective Jul 1, 2026
  • NY: $169.88 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $65.75 (physician), effective Jan 1, 2024
  • OK: $26.00 (asc), effective Jan 1, 2026
  • TX: $22.14 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $57.58 (medical), effective Jul 1, 2026
  • VT: $99.91 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $21.79 (physician, facility), effective Jul 1, 2026
  • WY: $56.91 (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.