58554 CPT® code: payer coverage and prior authorization76 of 76 payer prior-auth lists that name 58554 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Shield of California, Humana, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of South Carolina, Molina Healthcare of Texas, Molina Healthcare of Utah, and others.
58554 appears in 42 coverage policies from Aetna, Blue Cross & Blue Shield of Rhode Island, Blue Shield of California, Centene, Cigna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, 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 | Breast and Ovarian Cancer Susceptibility Gene Testing, Prophylactic Mastectomy, and Prophylactic Oophorectomy (0227) | covered if criteria are met (range 58541-58554) | Apr 14, 2026 | payer document |
| Aetna | Bupivacaine Liposome (Exparel) (0941) | listed, no stance (range 58541-58575) | Jul 30, 2026 | payer document |
| Aetna | Fibroid Treatment (0304) | not covered (range 58550-58554) | Apr 17, 2026 | payer document |
| Aetna | Gender Affirming Surgery (0615) | covered if criteria are met (range 58550-58554) | Sep 8, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | listed, no stance (range 58541-58554) | Jul 23, 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 | Gender Affirming Care MEDICAL COVERAGE POLICY | 3 | listed, no stance | Apr 1, 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 58541-58554) | Apr 1, 2026 | payer document |
| Blue Shield of California | BSC7.06 Power Morcellation for the Treatment of Uterine Fibroids | listed, no stance | payer document | |
| Centene | Gender-Affirming Procedures (CP.MP.95) | covered if criteria are met | Jul 1, 2026 | payer document |
| Cigna | Gender Dysphoria Treatment (0266) | covered if criteria are met | Sep 15, 2026 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Gender Assignment Surgery and Gender Reassignment Surgery with Related Services (SUR717.001) CPT Codes 11950, 11951, 11952, 11954, 11980, 11981, 11982, 11983, 15780, | listed, no stance | Jan 1, 2026 | payer document |
| Premera Blue Cross | Gender Transition/Affirmation Surgery and Related Services (7.01.557) Page | 32 of 59 | ∞ | listed, no stance | Jul 1, 2026 | payer document |
| Premera Blue Cross | Hysterectomy for Non-Malignant Conditions (7.01.548) Page | 9 of 22 | ∞ | listed, no stance | Jun 1, 2026 | payer document |
| Regence | Gender Affirming Interventions for Gender Dysphoria (Medicine 153) NOTES | listed, no stance | Nov 1, 2025 | payer document |
| Regence | Hysterectomy (Surgery 218) | listed, no stance | Jun 1, 2026 | payer document |
| Regence | Surgical Site of Care – Hospital Outpatient (Utilization Management 19) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (CS145.T) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (2026T0580U) | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for Indiana Only) (CS145IN.11) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for Kansas Only) (CS145KS.02) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for New Jersey Only) (CS145NJ.L) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for New Mexico Only) (CS145NM.D) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for North Carolina Only) (CSNCT0145.04) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for Ohio Only) (CS145OH.C) | listed, no stance | Sep 1, 2024 | payer document |
| UnitedHealthcare | Gender Dysphoria Treatment (for Pennsylvania Only) (CS145PA.P) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Gender Dysphoria and Gender Reassignment Surgery (MMP365.14) Female to Male | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (2026T0572Y) Laparoscopic-Assisted Vaginal | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (CS196.I) Laparoscopic-Assisted Vaginal | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (for Idaho Only) (CS196ID.C) Laparoscopic-Assisted Vaginal | listed, no stance | Jul 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (for Indiana Only) (CS314IN.06) Laparoscopic-Assisted Vaginal | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (for Kansas Only) (CS196KS.02) Laparoscopic-Assisted Vaginal | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (for Kentucky Only) (CS313KY.11) Laparoscopic-Assisted Vaginal | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (for Nebraska Only) (CS196NE.I) Laparoscopic-Assisted Vaginal | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (for New Jersey Only) (CS196NJ.G) Laparoscopic-Assisted Vaginal | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (for New Mexico Only) (CS196NM.C) Laparoscopic-Assisted Vaginal | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (for North Carolina Only) (CSNCT0572.08) Laparoscopic-Assisted Vaginal | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (for Ohio Only) (CS196OH.F) Laparoscopic-Assisted Vaginal | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (for Pennsylvania Only) (CS196PA.I) Laparoscopic-Assisted Vaginal | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Hysterectomy (for Tennessee Only) (CS196TN.I) Laparoscopic-Assisted Vaginal | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Uterine Services and Procedures (MMP098.11) | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in IN, KY, ND, WA, WV.
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.