Payer policies › CPT 5416054160 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 54160 7 of 7 payer prior-auth lists that name 54160 require prior authorization or set conditions: Humana, UnitedHealthcare Community Plan.
Payer Plan State Prior auth Conditions Since Source Humana Humana Puerto Rico MA and Dual Medicare-Medicaid PR prior auth required Nov 3, 2025 Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification UnitedHealthcare Community Plan ALTCS Developmentally Disabled AZ prior auth under conditions Prior authorization is required only for cases with documented medical necessity. Oct 1, 2026 Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026 UnitedHealthcare Community Plan ALTCS Long Term Care AZ prior auth under conditions Prior authorization is required only for cases with documented medical necessity. Oct 1, 2026 Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026 UnitedHealthcare Community Plan Texas CHIP TX prior auth under conditions Prior authorization required for members older than age 1 Jan 1, 2015 Prior 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 Plan Texas STAR TX prior auth required Jan 1, 2015 Prior 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 Plan Texas STAR Kids TX prior auth required Nov 1, 2016 Prior 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 Plan Texas STAR+PLUS TX prior auth under conditions Prior authorization is required for members older than age 1. Jan 1, 2015 Prior 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
Payer coverage policies that name 54160 54160 appears in 2 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Abdominoplasty, Suction Lipectomy, and Ventral Hernia Repair (0211) listed, no stance Aug 18, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance Jul 23, 2026 payer document
Recent prior-auth changes Jan 1, 2026: conditions changed, UnitedHealthcare Community Plan Nov 1, 2025: conditions changed, UnitedHealthcare Community Plan Medicaid fee-for-service CO: $128.87 (chp_plus, non-facility), effective Jul 1, 2026 FL: $218.43 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $99.80 (practitioner), effective Jul 8, 2019 IN: $112.72 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $250.00 (asc, facility), effective Aug 1, 1982 KY: $303.22 (asc), effective Jan 1, 2026 LA: $182.30 (asc), effective Jul 1, 2012 MA: $239.03 (asc), effective May 1, 2026 ND: $178.75 (physician, facility), effective Aug 1, 2026 NE: $552.00 (asc), effective Jul 1, 2024 NY: $73.01 (physician_surgery, facility), effective Jul 1, 2026 OH: $73.54 (physician, facility), effective Jan 1, 2024 OK: $276.64 (asc), effective Jan 1, 2026 TX: $238.15 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $114.58 (medical, facility), effective Jul 1, 2026 VT: $541.42 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $308.28 (asc), effective Jul 1, 2026 WY: $308.37 (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.