57305 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 57305

2 of 2 payer prior-auth lists that name 57305 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas, Humana.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross and Blue Shield of TexasTexas PA exemption (gold card), outpatient, fully insuredTXprior auth requiredGold-card exemption availableJul 1, 2026BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
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 57305

57305 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: $997.20 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $636.02 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $699.30 (physician, non-facility), effective Jan 1, 2026
  • IL: $1127.90 (practitioner), effective Jul 1, 2026
  • IN: $741.54 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $543.39 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $495.41 (physician, facility), effective Jan 1, 2026
  • LA: $158.87 (professional), effective Jul 1, 2025
  • MA: $736.54 (physician_surgery), effective May 1, 2024
  • MS: $748.41 (comprehensive), effective Jul 1, 2026
  • ND: $944.74 (physician), effective Aug 1, 2026
  • NE: $258.92 (physician, non-facility), effective Jul 1, 2026
  • NY: $423.50 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $612.87 (physician), effective Jan 1, 2024
  • OK: $791.12 (physician, non-facility), effective Jul 1, 2026
  • TX: $121.01 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2026
  • VA: $912.91 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $526.48 (physician, facility), effective Jul 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.