56605 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 56605

2 of 2 payer prior-auth lists that name 56605 require prior authorization or set conditions: Neighborhood Health Partnership, UnitedHealthcare.

PayerPlanStatePrior authConditionsSinceSource
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 56605

56605 appears in 2 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaAcupuncture and Dry Needling (0135)listed, no stance (range 56405-58999)Mar 25, 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, UnitedHealthcare Community Plan
  • Oct 1, 2026: PA removed, UnitedHealthcare
  • Oct 1, 2026: PA removed, Oxford Health Plans
  • 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

Medicaid fee-for-service

  • AZ: $28.47 (asc), effective Oct 1, 2026
  • CO: $75.05 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $40.67 (physician, facility), effective Jan 1, 2026
  • IL: $108.30 (practitioner), effective Jul 1, 2026
  • IN: $45.19 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $225.00 (asc, facility), effective Jan 1, 1993
  • KY: $50.79 (asc), effective Jan 1, 2026
  • LA: $76.76 (professional), effective Jul 1, 2025
  • MA: $40.49 (asc), effective May 1, 2026
  • MS: $41.40 (comprehensive, facility), effective Oct 1, 2025
  • ND: $50.24 (physician, facility), effective Aug 1, 2026
  • NE: $32.80 (physician, facility), effective Jul 1, 2026
  • NY: $28.18 (midwife, facility), effective Jul 1, 2026
  • OH: $30.31 (physician, facility), effective Jan 1, 2024
  • OK: $46.34 (asc), effective Jan 1, 2026
  • TX: $44.85 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $52.56 (medical, facility), effective Jul 1, 2026
  • VT: $715.16 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $29.81 (physician, facility), effective Jul 1, 2026
  • WY: $407.32 (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.