56501 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 56501

3 of 3 payer prior-auth lists that name 56501 require prior authorization or set conditions: Humana, Neighborhood Health Partnership, UnitedHealthcare.

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
Neighborhood Health PartnershipNeighborhood Health PartnershipFLprior auth under conditionssite of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WISep 1, 2026Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth under conditionssite of care: outpatient hospitalSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026

Payer coverage policies that name 56501

56501 appears in 4 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaAcupuncture and Dry Needling (0135)listed, no stance (range 56405-58999)Mar 25, 2026payer document
AetnaBenign Skin Lesion Removal (0633)covered if criteria are met (range 56501-56515)Sep 9, 2026payer document
AetnaCarbon Dioxide Laser (0427)covered if criteria are metJul 8, 2026payer document
AetnaUrological Supplies (0533)listed, no stance (range 56405-58999)Jul 30, 2026payer document

Recent prior-auth changes

  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, Oxford Health Plans
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Aug 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, UnitedHealthcare
  • Jul 1, 2026: conditions changed, Neighborhood Health Partnership
  • Apr 1, 2026: PA removed, UnitedHealthcare Community Plan

Medicaid fee-for-service

  • AZ: $68.88 (asc), effective Oct 1, 2026
  • CO: $148.85 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $134.05 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IL: $90.43 (practitioner), effective Apr 1, 2024
  • IN: $102.92 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $186.90 (asc, facility), effective Aug 1, 1982
  • KY: $122.88 (asc), effective Jan 1, 2026
  • LA: $151.08 (professional), effective Jul 1, 2025
  • MA: $88.04 (asc), effective May 1, 2026
  • MS: $101.18 (comprehensive, facility), effective Oct 1, 2025
  • ND: $121.54 (physician, facility), effective Aug 1, 2026
  • NE: $84.48 (physician, facility), effective Jul 1, 2026
  • NY: $52.64 (midwife, facility), effective Jul 1, 2026
  • OH: $68.70 (physician, facility), effective Jan 1, 2024
  • OK: $112.10 (asc), effective Jan 1, 2026
  • TX: $111.02 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $121.74 (medical, facility), effective Jul 1, 2026
  • VT: $1602.06 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $71.85 (physician, facility), effective Jul 1, 2026
  • WY: $912.46 (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.