`5250F` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 5250F

Payer coverage policies that name 5250F

5250F appears in 1 coverage policy 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

Medicaid fee-for-service

Prior authorization required or conditional in IN.

VT: $0.00 (outpatient_hospital_opps), effective Feb 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.

5250F CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 5250F

Payer coverage policies that name 5250F

Medicaid fee-for-service

`5250F` CPT® code: payer coverage and prior authorization