Payer policies › CPT 5586955869 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 55869 9 of 9 payer prior-auth lists that name 55869 require prior authorization or set conditions: CarePlus Health Plans, Humana.
Payer coverage policies that name 55869 55869 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Ablative Procedures for Prostate Cancer (0843) listed, no stance Feb 25, 2026 payer document
Recent prior-auth changes Jan 1, 2026: PA removed, Molina Healthcare of Michigan Jul 1, 2024: PA added, Molina Healthcare of Michigan Medicaid fee-for-service AZ: $3457.91 (asc), effective Oct 1, 2026 CO: $1044.73 (chp_plus, non-facility), effective Jul 1, 2026 FL: $1033.37 (physician, facility), effective Jan 1, 2026 IL: $958.87 (practitioner), effective Jan 1, 2026 IN: $1024.55 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KY: $1142.27 (physician, facility), effective Jan 1, 2026 LA: $182.30 (asc), effective Jan 1, 2026 MS: $4096.40 (comprehensive, facility), effective Jan 1, 2026 ND: $2946.55 (physician, facility), effective Aug 1, 2026 NY: $711.39 (physician_surgery, facility), effective Jul 1, 2026 OH: $1043.21 (code_changes), effective Jan 1, 2026 VA: $1168.05 (medical, facility), effective Jan 1, 2026 VT: $8253.65 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $446.73 (asc), effective Jul 1, 2026 WY: $4700.90 (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.