Payer policies › CPT 5179251792 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 51792 Payer coverage policies that name 51792 51792 appears in 3 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Bupivacaine Liposome (Exparel) (0941) listed, no stance (range 50010-53899) Jul 30, 2026 payer document Aetna Erectile Dysfunction and Peyronie's Disease (0007) not covered Jul 29, 2026 payer document Aetna Urinary Incontinence (0223) covered if criteria are met Jul 16, 2026 payer document
Medicaid fee-for-service AZ: $40.35 (outpatient_hospital), effective Oct 1, 2021 CO: $65.85 (chp_plus, non-facility), effective Jul 1, 2026 FL: $148.59 (physician), effective Jan 1, 2026 IL: $175.88 (practitioner), effective Apr 1, 2024 IN: $42.77 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 MA: $0.00 (asc), effective May 1, 2026 MS: $44.80 (comprehensive), effective Jul 1, 2026 ND: $59.70 (physician), effective Aug 1, 2026 NE: $296.40 (physician, non-facility), effective Jul 1, 2026 NY: $205.58 (physician_surgery, facility), effective Jul 1, 2026 OH: $156.22 (physician), effective Jan 1, 2024 OK: $159.63 (physician, non-facility), effective Jul 1, 2026 TX: $195.47 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2025 VA: $48.61 (medical), effective Jul 1, 2026 VT: $45.81 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $153.26 (physician, facility), effective Jul 1, 2026 WY: $26.09 (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.