Payer policies › CPT 5745657456 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 57456 2 of 2 payer prior-auth lists that name 57456 require prior authorization or set conditions: Neighborhood Health Partnership, UnitedHealthcare.
Payer Plan State Prior auth Conditions Since Source Neighborhood Health Partnership Neighborhood Health Partnership FL prior auth under conditions site of care: outpatient hospital; not in AK, IL, GU, MA, PR, RI, TX, UT, VI, WI Sep 1, 2026 Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 UnitedHealthcare UnitedHealthcare Complete (Individual & Family plans) All prior auth under conditions site of care: outpatient hospital Sep 1, 2026 Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
Payer coverage policies that name 57456 57456 appears in 2 coverage policies from Aetna.
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 Urological Supplies (0533) listed, no stance (range 56405-58999) Jul 30, 2026 payer document
Recent prior-auth changes Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, Oxford Health Plans Oct 1, 2026: PA removed, UnitedHealthcare Community Plan Aug 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 Jul 1, 2026: conditions changed, UnitedHealthcare Medicaid fee-for-service AZ: $43.71 (asc), effective Oct 1, 2026 CO: $114.55 (chp_plus, non-facility), effective Jul 1, 2026 FL: $69.36 (physician, facility), effective Jan 1, 2026 IL: $70.41 (practitioner), effective Apr 1, 2024 IN: $76.79 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $225.75 (asc, facility), effective Jan 1, 2003 KY: $77.98 (asc), effective Jan 1, 2026 LA: $122.03 (professional), effective Jul 1, 2025 MA: $62.58 (asc), effective May 1, 2026 MS: $62.37 (comprehensive, facility), effective Oct 1, 2025 ND: $77.14 (physician, facility), effective Aug 1, 2026 NE: $148.72 (physician, facility), effective Jul 1, 2026 NY: $48.32 (midwife, facility), effective Jul 1, 2026 OH: $70.79 (physician, facility), effective Jan 1, 2024 OK: $71.15 (asc), effective Jan 1, 2026 TX: $66.44 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $90.54 (medical, facility), effective Jul 1, 2026 VT: $236.61 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $51.60 (physician, facility), effective Jul 1, 2026 WY: $134.76 (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.