52284 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 52284

1 of 1 payer prior-auth lists that name 52284 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 52284

52284 appears in 3 coverage policies from Aetna, Regence.

PayerPolicyRole in policyReviewedDocument
AetnaBenign Prostatic Hyperplasia (0079)covered if criteria are metApr 15, 2026payer document
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 50010-53899)Jul 30, 2026payer document
RegenceDevices for Treatment of Benign Prostatic Hyperplasia, Urethral Stricture, and Urethral Stenosis (Surgery 230)listed, no stanceDec 1, 2025payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN, VA.

  • AZ: $2609.53 (asc), effective Oct 1, 2026
  • CO: $2157.57 (health_first_colorado), effective Jul 1, 2026
  • IL: $115.13 (practitioner), effective Jan 1, 2024
  • IN: $126.43 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KY: $3791.43 (asc), effective Jan 1, 2026
  • LA: $2096.05 (professional), effective Jan 1, 2024
  • MA: $2100.49 (asc), effective May 1, 2026
  • MS: $2652.56 (comprehensive, facility), effective Oct 1, 2025
  • ND: $2235.06 (physician, facility), effective Aug 1, 2026
  • NY: $137.55 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $124.42 (physician, facility), effective Jan 1, 2024
  • VA: $126.45 (medical, facility), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $2371.18 (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.