54500 CPT® code: payer coverage and prior authorization9 of 9 payer prior-auth lists that name 54500 require prior authorization or set conditions: Neighborhood Health Partnership, Oxford Health Plans, Surest, UnitedHealthcare.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | only with dx E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| Oxford Health Plans | Oxford Health Plans | All | prior auth required | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 | |
| Surest | Surest health plans | All | prior auth under conditions | only with dx E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | Oct 1, 2026 | Prior Authorization Requirements for Surest Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Commercial | All | prior auth under conditions | only with dx E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth under conditions | only with dx E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth under conditions | The following codes only require prior authorization if the Dx code is also listed: | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Mid-Atlantic Health Plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare West commercial plans | All | prior auth under conditions | only with dx E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare of the River Valley | All | prior auth under conditions | only with dx E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026 |
54500 appears in 6 coverage policies from Aetna, Blue Shield of California, BlueCross BlueShield of South Carolina, Cigna, Premera Blue Cross, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Infertility (0327) | covered if criteria are met | Jul 16, 2026 | payer document |
| Blue Shield of California | | Reproductive Techniques (4.02.04) | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Reproductive Techniques (CAM 40204) | listed, no stance | Apr 1, 2026 | payer document |
| Cigna | Infertility Services (0089) | covered if criteria are met | Jun 15, 2025 | payer document |
| Premera Blue Cross | Infertility and Assisted Reproduction Services | listed, no stance | May 11, 2026 | payer document |
| UnitedHealthcare | Infertility Diagnosis, Treatment, and Fertility Preservation (2026T0270NN) | listed, no stance | Jun 1, 2026 | payer document |
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.