55000 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 55000

1 of 1 payer prior-auth lists that name 55000 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

Payer coverage policies that name 55000

55000 appears in 1 coverage policy from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaInfertility (0327)covered if criteria are metJul 16, 2026payer document

Medicaid fee-for-service

  • AZ: $40.59 (asc), effective Oct 1, 2026
  • CO: $83.89 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $116.70 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IL: $57.71 (practitioner), effective Apr 1, 2024
  • IN: $65.42 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $250.00 (asc, facility), effective Aug 1, 1982
  • KY: $72.41 (asc), effective Jan 1, 2026
  • LA: $233.58 (asc), effective Jul 1, 2012
  • MA: $54.60 (asc), effective May 1, 2026
  • MS: $51.75 (comprehensive, facility), effective Oct 1, 2025
  • ND: $71.63 (physician, facility), effective Aug 1, 2026
  • NE: $15.78 (physician, facility), effective Jul 1, 2026
  • NY: $42.81 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $53.12 (physician, facility), effective Jan 1, 2024
  • OK: $66.06 (asc), effective Jan 1, 2026
  • TX: $54.26 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $66.84 (medical, facility), effective Jul 1, 2026
  • VT: $549.84 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $45.48 (physician, facility), effective Jul 1, 2026
  • WY: $313.16 (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.