58145 CPT® code: payer coverage and prior authorization9 of 9 payer prior-auth lists that name 58145 require prior authorization or set conditions: Humana, Neighborhood Health Partnership, Oxford Health Plans, Surest, UnitedHealthcare.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| 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 | |
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | only with dx E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| Oxford Health Plans | Oxford Health Plans | All | prior auth required | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 | |
| Surest | Surest health plans | All | prior auth under conditions | only with dx E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | Oct 1, 2026 | Prior Authorization Requirements for Surest Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Commercial | All | prior auth under conditions | only with dx E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | 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 E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth under conditions | The following codes only require prior authorization if the Dx code is also listed: | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare West commercial plans | All | prior auth under conditions | only with dx E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | 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 E23.0, N46.01, N46.021, N46.022, N46.023, N46.024 | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026 |
58145 appears in 8 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Cigna, 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 | Endometrial Ablation (0091) | listed, no stance (range 58100-58294) | Mar 25, 2026 | payer document |
| Aetna | Fibroid Treatment (0304) | not covered (range 58140-58146) | Apr 17, 2026 | payer document |
| Aetna | Infertility (0327) | covered if criteria are met | Jul 16, 2026 | payer document |
| Aetna | Urological Supplies (0533) | listed, no stance (range 56405-58999) | Jul 30, 2026 | payer document |
| Blue Cross & Blue Shield of Rhode Island | Laparoscopic, Percutaneous, and Transcervical Techniques for the Myolysis of Uterine Fibroids & Hysterectomies MEDICAL COVERAGE POLICY | 3 | covered if criteria are met (range 58140-58294) | Apr 1, 2026 | payer document |
| Cigna | Infertility Services (0089) | covered if criteria are met | Jun 15, 2025 | payer document |
| UnitedHealthcare | Infertility Diagnosis, Treatment, and Fertility Preservation (2026T0270NN) | listed, no stance | Jun 1, 2026 | payer document |
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.