52276 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 52276

26 of 26 payer prior-auth lists that name 52276 require prior authorization or set conditions: Humana, Neighborhood Health Partnership, Oxford Health Plans, UnitedHealthcare, UnitedHealthcare Community Plan.

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
Neighborhood Health PartnershipNeighborhood Health PartnershipFLprior auth under conditionssite of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WISep 1, 2026Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Oxford Health PlansOxford Health PlansAllprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior Authorization Requirements for Oxford Effective October 1, 2026
UnitedHealthcareUnitedHealthcare CommercialAllprior auth under conditionssite of care: outpatient hospital; not in AK, GU, IL, MA, PR, RI, TX, UT, VI, WIOct 1, 2026Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth under conditionssite of care: outpatient hospitalSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Individual Exchange plansAllprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare of the River ValleyAllprior auth under conditionssite of care: outpatient hospital; not in AK, IL, MA, PR, RI, TX, UT, VI, WIOct 1, 2026Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026
UnitedHealthcare Community PlanAHCCCS Complete Care (ACC)AZprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026
UnitedHealthcare Community PlanALTCS Developmentally DisabledAZprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026
UnitedHealthcare Community PlanMaryland HealthChoiceMDprior auth under conditionssite of care: outpatient hospitalSep 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community PlanMichigan Medicaid, Healthy Michigan Plan, CSHCSMIprior auth under conditionssite of care: outpatient hospital, ASCOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Michigan, Healthy Michigan Plan and Children’s Special Health Care Services Effective October 1, 2026
UnitedHealthcare Community PlanMississippi CHIPMSprior auth under conditionssite of care: outpatient hospitalApr 1, 2025Prior authorization requirements for Mississippi Children’s Health Insurance Program Effective Apr. 1, 2025
UnitedHealthcare Community PlanMississippiCANMSprior auth under conditionssite of care: outpatient hospitalApr 1, 2025Prior authorization requirements for UnitedHealthcare Community Plan of Mississippi – Mississippi Coordinated Access Network (MississippiCAN) Effective Apr. 1, 2025
UnitedHealthcare Community PlanMissouri MedicaidMOprior auth under conditionssite of care: outpatient hospitalJul 1, 2026Prior authorization requirements for Missouri Medicaid Effective July 1, 2026
UnitedHealthcare Community PlanNew Jersey FamilyCareNJprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U
UnitedHealthcare Community PlanNorth Carolina MedicaidNCprior auth under conditionssite of care: outpatient hospital, ASCOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of North Carolina Effective October 1, 2026 July 1, 2024
UnitedHealthcare Community PlanOhio MedicaidOHprior auth under conditionssite of care: outpatient hospital, ASCNov 1, 2025Prior authorization requirements for Ohio Medicaid Effective November 1, 2025 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community Plan
UnitedHealthcare Community PlanPennsylvania CHIPPAprior auth under conditionssite of care: outpatient hospitalJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026
UnitedHealthcare Community PlanPennsylvania MedicaidPAprior auth under conditionssite of care: outpatient hospitalJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026
UnitedHealthcare Community PlanRhode Island MedicaidRIprior auth under conditionssite of care: outpatient hospitalMay 1, 2026Prior authorization requirements for Rhode Island Medicaid Effective May 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan of Rhode Island h
UnitedHealthcare Community PlanTexas CHIPTXprior auth under conditionssite of care: outpatient hospitalJul 1, 2020Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care
UnitedHealthcare Community PlanTexas STARTXprior auth under conditionssite of care: outpatient hospitalJul 1, 2020Prior authorization requirements for Texas STAR Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR h
UnitedHealthcare Community PlanTexas STAR KidsTXprior auth under conditionssite of care: outpatient hospitalJul 1, 2020Prior authorization requirements for STAR Kids Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR Ki
UnitedHealthcare Community PlanTexas STAR+PLUSTXprior auth under conditionssite of care: outpatient hospitalJul 1, 2020Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of New YorkNYprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026
UnitedHealthcare Community PlanWashington Apple HealthWAprior auth under conditionssite of care: outpatient hospitalOct 1, 2026Prior authorization requirements for the UnitedHealthcare Community Plan of Washington Effective April 1, 2023

Payer coverage policies that name 52276

52276 appears in 2 coverage policies from Aetna, Centene.

PayerPolicyRole in policyReviewedDocument
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 50010-53899)Jul 30, 2026payer document
CenteneAmbulatory Surgery Center Optimization Reference Number: CP.MP.158 (CP.MP.158)
References reviewed and updated | 01/19 | 01/19		covered if criteria are metJun 1, 2022payer document

Recent prior-auth changes

  • Oct 1, 2026: conditions changed, UnitedHealthcare Community Plan
  • Aug 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, Neighborhood Health Partnership
  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Nov 1, 2025: conditions changed, UnitedHealthcare Community Plan
  • Nov 1, 2025: conditions changed, UnitedHealthcare Community Plan
  • Nov 1, 2025: conditions changed, UnitedHealthcare Community Plan
  • Oct 1, 2025: conditions changed, UnitedHealthcare Community Plan

Medicaid fee-for-service

  • AZ: $690.65 (asc), effective Oct 1, 2026
  • CO: $205.16 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $181.58 (physician, non-facility), effective Jan 1, 2026
  • IL: $209.40 (practitioner), effective Jul 1, 2026
  • IN: $202.49 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $350.00 (asc, facility), effective Aug 1, 1982
  • KY: $978.05 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $671.25 (asc), effective May 1, 2026
  • MS: $767.90 (comprehensive, facility), effective Oct 1, 2025
  • ND: $576.56 (physician, facility), effective Aug 1, 2026
  • NE: $637.00 (asc), effective Jul 1, 2024
  • NY: $135.95 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $248.49 (physician), effective Jan 1, 2010
  • OK: $892.30 (asc), effective Jan 1, 2026
  • TX: $652.80 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $202.26 (medical), effective Jul 1, 2026
  • VT: $1623.10 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $308.28 (asc), effective Jul 1, 2026
  • WY: $924.45 (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.