51925 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 51925

4 of 4 payer prior-auth lists that name 51925 require prior authorization or set conditions: Blue Shield of California, UnitedHealthcare Community Plan.

PayerPlanStatePrior authConditionsSinceSource
Blue Shield of CaliforniaBlue Shield MedicareCAprior auth requiredSep 1, 2026Prior Authorization List for Blue Shield Medicare
Blue Shield of CaliforniaBlue Shield commercialCAprior auth requiredSep 1, 2026Prior Authorization List for Blue Shield
UnitedHealthcare Community PlanIndiana Hoosier Care ConnectINprior auth requiredOct 1, 2026Prior authorization requirements for Indiana Hoosier Care Connect Effective October 1, 2026
UnitedHealthcare Community PlanIndiana PathWays for Aging (MLTSS)INprior auth requiredOct 1, 2026Prior authorization requirements for Indiana MLTSS Pathways Effective October 1, 2026

Payer coverage policies that name 51925

51925 appears in 2 coverage policies from Aetna, Blue Shield of California.

PayerPolicyRole in policyReviewedDocument
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 50010-53899)Jul 30, 2026payer document
Blue Shield of CaliforniaBSC7.09 Hysterectomy Surgery for Benign Conditionslisted, no stancepayer document

Medicaid fee-for-service

Prior authorization required or conditional in IN, KY, WA.

  • AZ: $1101.10 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $785.68 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $742.46 (physician, non-facility), effective Jan 1, 2026
  • IL: $958.60 (practitioner), effective May 14, 2025
  • IN: $821.33 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $395.61 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $740.46 (physician, facility), effective Jan 1, 2026
  • LA: $875.60 (professional), effective Jul 1, 2025
  • MA: $806.32 (physician_surgery), effective May 1, 2024
  • MS: $793.13 (comprehensive), effective Jul 1, 2026
  • ND: $996.18 (physician), effective Aug 1, 2026
  • NE: $2037.74 (physician, non-facility), effective Jul 1, 2026
  • NY: $554.30 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $706.46 (physician), effective Jan 1, 2000
  • OK: $836.92 (physician, non-facility), effective Jul 1, 2026
  • TX: $111.39 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026
  • VA: $819.16 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $552.47 (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.