Payer policies › CPT 5811058110 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 58110 Payer coverage policies that name 58110 58110 appears in 4 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 Endometrial Ablation (0091) listed, no stance (range 58100-58294) Mar 25, 2026 payer document Aetna Endometrial Cancer Screening, Diagnosis, and Prognosis (0769) covered if criteria are met Oct 3, 2025 payer document Aetna Urological Supplies (0533) listed, no stance (range 56405-58999) Jul 30, 2026 payer document
Medicaid fee-for-service AZ: $10.11 (outpatient_hospital, RF133), effective Oct 1, 2025 CO: $40.42 (chp_plus, non-facility), effective Jul 1, 2026 FL: $27.80 (physician, facility), effective Jan 1, 2026 IL: $28.04 (practitioner), effective Apr 1, 2024 IN: $30.76 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $34.21 (default, Exempt Physician), effective Aug 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $40.60 (professional), effective Jul 1, 2025 MA: $0.00 (asc), effective May 1, 2026 MS: $42.22 (comprehensive), effective Jul 1, 2026 ND: $54.45 (physician), effective Aug 1, 2026 NE: $31.85 (physician, facility), effective Jul 1, 2026 NY: $19.33 (midwife, facility), effective Jul 1, 2026 OH: $30.63 (physician, facility), effective Jan 1, 2024 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $29.75 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), facility), effective Mar 1, 2026 VA: $35.95 (medical, facility), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $20.26 (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.