Payer policies › CPT 5235452354 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 52354 2 of 2 payer prior-auth lists that name 52354 require prior authorization or set conditions: Neighborhood Health Partnership, UnitedHealthcare.
Payer Plan State Prior auth Conditions Since Source Neighborhood Health Partnership Neighborhood Health Partnership FL prior auth under conditions site of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WI Sep 1, 2026 Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 UnitedHealthcare UnitedHealthcare Complete (Individual & Family plans) All prior auth under conditions site of care: outpatient hospital Sep 1, 2026 Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
Payer coverage policies that name 52354 52354 appears in 2 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 Urological Supplies (0533) listed, no stance Jul 30, 2026 payer document
Recent prior-auth changes Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, Oxford Health Plans Oct 1, 2026: PA removed, UnitedHealthcare Community Plan Aug 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, UnitedHealthcare Jul 1, 2026: conditions changed, Neighborhood Health Partnership Medicaid fee-for-service AZ: $1977.90 (asc), effective Oct 1, 2026 CO: $335.31 (chp_plus, non-facility), effective Jul 1, 2026 FL: $284.97 (physician, non-facility), effective Jan 1, 2026 IL: $283.37 (practitioner), effective Apr 1, 2024 IN: $318.96 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $600.00 (asc, facility), effective Jan 1, 2001 KY: $2664.56 (asc), effective Jan 1, 2026 LA: $217.00 (asc), effective Jul 1, 2012 MA: $1679.83 (asc), effective May 1, 2026 MS: $2017.28 (comprehensive, facility), effective Oct 1, 2025 ND: $1570.76 (physician, facility), effective Aug 1, 2026 NE: $785.00 (asc), effective Jul 1, 2024 NY: $201.09 (physician_surgery, facility), effective Jul 1, 2026 OH: $328.70 (physician), effective Jan 1, 2024 OK: $2430.93 (asc), effective Jan 1, 2026 TX: $1689.43 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $317.42 (medical), effective Jul 1, 2026 VT: $4163.23 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $366.60 (asc), effective Jul 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.