`56805` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 56805

72 of 72 payer prior-auth lists that name 56805 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of New Mexico, Blue Shield of California, Blue Shield of California Promise Health Plan, Cigna, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Neighborhood Health Partnership, and others.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Blue Cross Blue Shield of Arizona (AZ Blue)	Federal Employee Program (FEP)	AZ	prior auth under conditions	Only gender dysphoria dx, members in treatment as of 1/1/26	Sep 1, 2026	Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)
Blue Shield of California	Blue Shield Medicare	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield Medicare
Blue Shield of California	Blue Shield commercial	CA	prior auth required		Sep 1, 2026	Prior Authorization List for Blue Shield
Blue Shield of California Promise Health Plan	Promise Health Plan Medi-Cal	CA	prior auth required		Sep 1, 2026	Medi-Cal Prior Authorization List
Aetna	Commercial	All	prior auth required		Aug 1, 2024	Participating provider behavioral health precertification list for Aetna
Aetna	Medicare Advantage	All	prior auth required		Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Medicare Advantage	All	prior auth required		Aug 1, 2024	Participating provider behavioral health precertification list for Aetna
Aetna	Commercial	All	prior auth required		Oct 1, 2026	Participating provider precertification list for Aetna®
Cigna	ACA/IFP	All	prior auth required	May be delegated to eviCore for some clients	Feb 16, 2015	Master Precertification List (For Health Care Providers)
Cigna	Basic Standard	All	prior auth required	May be delegated to eviCore for some clients	Feb 16, 2015	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required	May be delegated to eviCore for some clients	Feb 16, 2015	Master Precertification List (For Health Care Providers)
Cigna	Other Services	All	prior auth required		Mar 7, 2026	Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
Cigna	Other Services	All	prior auth required		Mar 7, 2026	Cigna Commercial Prior Authorization Procedure Code List: Other Services
Blue Cross and Blue Shield of Illinois	Blue Cross Community Health Plans (BCCHP), Illinois Medicaid	IL	prior auth required		Oct 1, 2026	Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026
Blue Cross and Blue Shield of Illinois	Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative)	IL	prior auth required		Jan 1, 2025	Procedure Code List, Effective 1/1/2025
Blue Cross and Blue Shield of New Mexico	Turquoise Care (New Mexico Medicaid)	NM	prior auth required		Oct 1, 2026	New Mexico Medicaid Benefit Preauthorization Procedure Code List 10/1/26
Humana	Humana Healthy Horizons	LA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Louisiana Prior Authorization and Notification List To Except where noted via links on the following pages, prior authorization requests for medical services may be initiate
Humana	Humana Healthy Horizons	OH	prior auth required		Jan 1, 2027	555201OH0924-B OHHMZG2EN Humana Healthy Horizons® in Ohio Prior Authorization Notification List (PAL) The following preauthorization and notification list
Humana	Humana Puerto Rico MA and Dual Medicare-Medicaid	PR	prior auth required		Nov 3, 2025	Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification
Molina Complete Care (Virginia)	Medicaid	VA	prior auth required		Apr 1, 2025	Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
Molina Healthcare of California	Medicaid	CA	prior auth required		Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of Idaho	Medicaid	ID	prior auth required		Jan 1, 2025	Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
Molina Healthcare of Illinois	Medicaid	IL	prior auth required		Jan 1, 2022	Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of Iowa	Medicaid	IA	prior auth under conditions	no PA with cancer dx	Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023
Molina Healthcare of Michigan	Medicaid	MI	prior auth under conditions	no PA with cancer dx	Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Michigan	Medicare Advantage	MI	prior auth under conditions	no PA with cancer dx	Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Mississippi	Medicaid	MS	prior auth under conditions	no PA with cancer dx	Jan 1, 2025	Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
Molina Healthcare of New Mexico	Medicaid	NM	prior auth under conditions	no PA with cancer dx	Jul 1, 2026	New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026
Molina Healthcare of Ohio	Medicaid and MyCare Ohio (MMP) Medicaid	OH	prior auth under conditions	no PA with cancer dx	Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Medicare and MyCare Ohio (MMP) Medicare	OH	prior auth under conditions	no PA with cancer dx	Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Exchange	OH	prior auth under conditions	no PA with cancer dx	Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Texas	STAR	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19
Molina Healthcare of Texas	STAR+PLUS	TX	prior auth required		Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19
Molina Healthcare of Texas	STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix)	TX	prior auth under conditions	no PA with cancer dx	Jan 1, 2023	Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3
Molina Healthcare of Texas	Exchange	TX	prior auth required		Jan 1, 2023	Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026
Molina Healthcare of Utah	Medicaid	UT	prior auth required		Jan 1, 2025	Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth under conditions	no PA with cancer dx	Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
Neighborhood Health Partnership	Neighborhood Health Partnership	FL	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Sep 1, 2026	Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Oxford Health Plans	Oxford Health Plans	All	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.8901	Oct 1, 2026	Prior Authorization Requirements for Oxford Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans CHP+	CO	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Oct 1, 2026	Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Health Plans Prime / RAE	CO	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Oct 1, 2026	Rocky Mountain Health Plans PRIME Effective October 1, 2026
Rocky Mountain Health Plans	Rocky Mountain Medicare Advantage D-SNP	CO	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Feb 1, 2025	Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
Surest	Surest health plans	All	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.8901	Oct 1, 2026	Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcare	Preferred Care Network and Preferred Care Partners of Florida	FL	prior auth under conditions	only with dx F64.A, F64.0, F64.1, F64.2, F64.8, F64.9	Oct 1, 2026	Prior authorization requirements for Preferred Care Network and Preferred Care Partners of Florida Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Commercial	All	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Complete (Individual & Family plans)	All	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcare	UnitedHealthcare Individual Exchange plans	All	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890; not in AL, AZ, FL, IA, IN, KS, LA, MO, MS, NE, NM, OH, OK, SC, TN, TX, WY	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Medicare Advantage, Peoples Health and Dual Complete (D-SNP)	All	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, F64.A	Oct 1, 2026	UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare Mid-Atlantic Health Plans	All	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.8901	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare West commercial plans	All	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.8901	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare West commercial plans Effective October 1, 2026
UnitedHealthcare	UnitedHealthcare of the River Valley	All	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.8901	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026
UnitedHealthcare Community Plan	KanCare	KS	prior auth required		Oct 1, 2026	Prior authorization requirements for Kansas Medicaid Effective October 1, 2026
UnitedHealthcare Community Plan	Maryland HealthChoice	MD	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Sep 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Maryland Effective September 1, 2026
UnitedHealthcare Community Plan	Massachusetts OneCare	MA	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Nov 1, 2025	Prior authorization requirements for Massachusetts OneCare Effective November 1, 2025
UnitedHealthcare Community Plan	Massachusetts Senior Care Options (SCO)	MA	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Nov 1, 2025	CPT® is a registered trademark of the American Medical Association. Prior authorization requirements for Massachusetts Senior Care Options Effective November 1, 2025
UnitedHealthcare Community Plan	Massachusetts Senior Care Options (SCO) and OneCare	MA	prior auth required		Oct 1, 2026	Prior authorization requirements for Massachusetts MA SCO OneCare Effective October 1, 2026
UnitedHealthcare Community Plan	Minnesota Metro Medicaid	MN	prior auth required		Oct 1, 2024	Prior authorization requirements for Minnesota Medicaid Effective October 1, 2024
UnitedHealthcare Community Plan	New Jersey FamilyCare	NJ	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U
UnitedHealthcare Community Plan	North Carolina Medicaid	NC	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of North Carolina Effective October 1, 2026 July 1, 2024
UnitedHealthcare Community Plan	Ohio Medicaid	OH	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Nov 1, 2025	Prior authorization requirements for Ohio Medicaid Effective November 1, 2025 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community Plan
UnitedHealthcare Community Plan	Pennsylvania CHIP	PA	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026
UnitedHealthcare Community Plan	Pennsylvania Medicaid	PA	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026
UnitedHealthcare Community Plan	Rhode Island Medicaid	RI	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	May 1, 2026	Prior authorization requirements for Rhode Island Medicaid Effective May 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan of Rhode Island h
UnitedHealthcare Community Plan	TennCare	TN	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Tennessee Effective October 1, 2026
UnitedHealthcare Community Plan	Texas CHIP	TX	prior auth under conditions	Dx group: Gender; Prior authorization is required for these codes with any DX Prior authorization is only required for these codes with these DX codes	Jul 1, 2018	Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care
UnitedHealthcare Community Plan	Texas STAR	TX	prior auth under conditions	Dx group: Gender; Prior authorization is only required for these DX codes.	Jul 1, 2018	Prior authorization requirements for Texas STAR Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR h
UnitedHealthcare Community Plan	Texas STAR Kids	TX	prior auth under conditions	Dx group: Gender; Prior authorization is only required for these codes with DX codes.	Jul 1, 2018	Prior authorization requirements for STAR Kids Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR Ki
UnitedHealthcare Community Plan	Texas STAR+PLUS	TX	prior auth under conditions	Dx group: Gender; Prior authorization is only required for these codes with these DX codes.	Sep 1, 2026	Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of Kentucky	KY	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Jul 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of New York	NY	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026
UnitedHealthcare Community Plan	UnitedHealthcare Connected (Texas MMP)	TX	prior auth under conditions	Prior authorization is only required for these codes with these DX codes.	Jan 1, 2017	Prior authorization requirements for UnitedHealthcare Connected (Medicare-Medicaid Plan) Texas Effective November 1, 2025 This list contains prior authorization review requirements for participating U
UnitedHealthcare Community Plan	Wisconsin BadgerCare Plus and Medicaid SSI	WI	prior auth under conditions	only with dx F64.0, F64.1, F64.2, F64.8, F64.9, Z87.890	Sep 1, 2026	Prior authorization requirements for Wisconsin Medicaid Effective September 1, 2026 General Information This list contains prior authorization requirements for participating UnitedHealthcare Community

Payer coverage policies that name 56805

56805 appears in 25 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Acupuncture and Dry Needling (0135)	listed, no stance (range 56405-58999)	Mar 25, 2026	payer document
Aetna	Cosmetic Surgery and Procedures (0031) Thermal therapy (e.g., radiofrequency (ThermiVa and Viveve procedures) and laser), Laviv (azficel-T)	not covered	Jun 25, 2026	payer document
Aetna	Gender Affirming Surgery (0615)	covered if criteria are met	Sep 8, 2026	payer document
Aetna	Urological Supplies (0533)	listed, no stance (range 56405-58999)	Jul 30, 2026	payer document
Anthem	Cosmetic and Reconstructive Services of the Trunk, Groin, and Extremities (ANC.00009)	not covered	Aug 13, 2026	payer document
Blue Cross & Blue Shield of Rhode Island	Gender Affirming Care Medicare Advantage Plans and Commercial Products	listed, no stance	Apr 1, 2026	payer document
Blue Cross Blue Shield of Massachusetts	Gender Affirming Services (Transgender Services) (189)	covered if criteria are met		payer document
Blue Cross Blue Shield of Massachusetts	Gender Affirming Services (Transgender Services) (189)	listed, no stance		payer document
Blue Cross NC	Sex Trait Modification Procedures For Gender Affirming Care	listed, no stance	Apr 1, 2026	payer document
Blue Shield of California	BSC7.02 \| Gender Affirmation Surgery	listed, no stance		payer document
Blue Shield of California	BSC7.08 \| Cosmetic and Reconstructive Procedures	listed, no stance		payer document
Centene	Gender-Affirming Procedures (CP.MP.95)	covered if criteria are met	Jul 1, 2026	payer document
Cigna	Gender Dysphoria Treatment (0266)	covered if criteria are met	Sep 15, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Gender Assignment Surgery and Gender Reassignment Surgery with Related Services (SUR717.001) CPT Codes 11950, 11951, 11952, 11954, 11980, 11981, 11982, 11983, 15780,	listed, no stance	Jan 1, 2026	payer document
Premera Blue Cross	Gender Transition/Affirmation Surgery and Related Services (7.01.557) Page \| 32 of 59 \| ∞	listed, no stance	Jul 1, 2026	payer document
Regence	Gender Affirming Interventions for Gender Dysphoria (Medicine 153) NOTES	listed, no stance	Nov 1, 2025	payer document
UnitedHealthcare	Gender Dysphoria Treatment (2026T0580U)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Gender Dysphoria Treatment (CS145.T)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Gender Dysphoria Treatment (for Indiana Only) (CS145IN.11)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Gender Dysphoria Treatment (for Kansas Only) (CS145KS.02)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Gender Dysphoria Treatment (for New Jersey Only) (CS145NJ.L)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Gender Dysphoria Treatment (for New Mexico Only) (CS145NM.D)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Gender Dysphoria Treatment (for North Carolina Only) (CSNCT0145.04)	listed, no stance	Jun 1, 2026	payer document
UnitedHealthcare	Gender Dysphoria Treatment (for Ohio Only) (CS145OH.C)	listed, no stance	Sep 1, 2024	payer document
UnitedHealthcare	Gender Dysphoria Treatment (for Pennsylvania Only) (CS145PA.P)	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Gender Dysphoria and Gender Reassignment Surgery (MMP365.14) Male to Female	listed, no stance	Sep 1, 2026	payer document

Recent prior-auth changes

Oct 1, 2026: conditions changed, UnitedHealthcare
Oct 1, 2026: conditions changed, Surest
Oct 1, 2026: conditions changed, UnitedHealthcare
Oct 1, 2026: conditions changed, UnitedHealthcare
Oct 1, 2026: conditions changed, UnitedHealthcare
Oct 1, 2026: conditions changed, UnitedHealthcare
Oct 1, 2026: conditions changed, Oxford Health Plans
Apr 1, 2026: conditions changed, UnitedHealthcare
Apr 1, 2026: conditions changed, Molina Healthcare of Michigan
Mar 1, 2026: conditions changed, UnitedHealthcare

Medicaid fee-for-service

Prior authorization required or conditional in CO, FL, IN, ND, VT, WA, WV.

AZ: $1051.19 (asc), effective Oct 1, 2026
CO: $930.50 (chp_plus, non-facility), effective Jul 1, 2026
FL: $1167.67 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
IL: $810.26 (practitioner), effective Apr 1, 2024
IN: $889.99 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
KY: $1696.62 (asc), effective Jan 1, 2026
MA: $1050.01 (asc), effective May 1, 2026
ND: $1000.16 (physician, facility), effective Aug 1, 2026
NE: $889.20 (physician, non-facility), effective Jul 1, 2026
NY: $556.92 (physician_surgery, facility), effective Jul 1, 2026
OH: $789.45 (physician), effective Jan 1, 2024
OK: $1547.86 (asc), effective Jan 1, 2026
TX: $1063.52 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
VA: $1039.74 (medical), effective Jul 1, 2026
VT: $2513.50 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $339.40 (asc), effective Jul 1, 2026
WY: $1431.58 (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.

56805 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 56805

Payer coverage policies that name 56805

Recent prior-auth changes

Medicaid fee-for-service

`56805` CPT® code: payer coverage and prior authorization