58605 CPT® code: payer coverage and prior authorization5 of 5 payer prior-auth lists that name 58605 require prior authorization or set conditions: Humana, UnitedHealthcare Community Plan.
| 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 | |
| UnitedHealthcare Community Plan | AHCCCS Complete Care (ACC) | AZ | prior auth under conditions | For all members younger than 21: Prior authorization required Any member requesting sterilization must sign an appropriate Consent for Sterilization form. | Oct 1, 2026 | Prior authorization requirements for AHCCCS Complete Care (ACC) Medicaid effective October 1, 2026 |
| UnitedHealthcare Community Plan | ALTCS Developmentally Disabled | AZ | prior auth required | Oct 1, 2026 | Prior authorization requirements for Arizona Developmental Disabilities Effective October 1, 2026 | |
| UnitedHealthcare Community Plan | ALTCS Long Term Care | AZ | prior auth under conditions | For all members younger than age 21: Prior authorization is required. | Oct 1, 2026 | Prior authorization requirements for Arizona Long Term Care Effective October 1, 2026 |
| UnitedHealthcare Community Plan | New Mexico Turquoise Care | NM | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of New Mexico Effective October 1, 2026 |
58605 appears in 6 coverage policies from Aetna, BlueCross BlueShield of South Carolina, Premera Blue Cross, 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 | Tubal Sterilization (0657) | covered if criteria are met | Oct 7, 2026 | payer document |
| Aetna | Urological Supplies (0533) | listed, no stance (range 56405-58999) | Jul 30, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Maternity/Obstetrical Care Benefits (CAM 366) | listed, no stance | Feb 1, 2026 | payer document |
| Premera Blue Cross | Preventive Care | covered if criteria are met | Sep 21, 2026 | payer document |
| UnitedHealthcare | Preventive Care Services (MP.016.59) Sterilizations) | Tubal Ligation, Oviduct | requirements for preventive benefits to | listed, no stance | Jul 1, 2026 | payer document |
Prior authorization required or conditional in KY.
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.