54560 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 54560

1 of 1 payer prior-auth lists that name 54560 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

Medicaid fee-for-service

  • AZ: $690.65 (asc), effective Oct 1, 2026
  • CO: $374.14 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $675.70 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IL: $480.00 (practitioner), effective Jul 1, 2026
  • IN: $533.03 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $400.00 (asc, facility), effective Aug 1, 1982
  • KY: $978.05 (asc), effective Jan 1, 2026
  • LA: $566.04 (professional), effective Feb 1, 2013
  • MA: $671.25 (asc), effective May 1, 2026
  • MS: $767.90 (comprehensive, facility), effective Oct 1, 2025
  • ND: $576.56 (physician, facility), effective Aug 1, 2026
  • NE: $1278.21 (physician, non-facility), effective Jul 1, 2026
  • NY: $347.08 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $509.87 (physician), effective Jan 1, 2024
  • OK: $555.16 (physician, non-facility), effective Jul 1, 2026
  • TX: $652.80 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $539.93 (medical), effective Jul 1, 2026
  • VT: $1623.10 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $308.28 (asc), effective Jul 1, 2026
  • WY: $924.45 (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.