57230 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 57230

1 of 1 payer prior-auth lists that name 57230 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 57230

57230 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

Medicaid fee-for-service

  • AZ: $1051.19 (asc), effective Oct 1, 2026
  • CO: $261.89 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $289.90 (physician, non-facility), effective Jan 1, 2026
  • IL: $517.40 (practitioner), effective Jul 30, 2019
  • IN: $320.68 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $149.30 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $1696.62 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $1050.01 (asc), effective May 1, 2026
  • MS: $1339.41 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1000.16 (physician, facility), effective Aug 1, 2026
  • NE: $637.00 (asc), effective Jul 1, 2024
  • NY: $190.01 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $272.32 (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: $378.46 (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.