58822 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 58822

1 of 1 payer prior-auth lists that name 58822 require prior authorization or set conditions: Humana.

PayerPlanStatePrior authConditionsSinceSource
HumanaHumana Puerto Rico MA and Dual Medicare-MedicaidPRprior auth requiredNov 3, 2025Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plans Preauthorization and Notification List Puerto Rico Medicare Advantage and Dual Medicare-Medicaid Plan Preauthorization and Notification

Payer coverage policies that name 58822

58822 appears in 4 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaAcupuncture and Dry Needling (0135)listed, no stance (range 56405-58999)Mar 25, 2026payer document
AetnaInfertility (0327)covered if criteria are metJul 16, 2026payer document
AetnaUltrasound Guidance – Selected Indications (0952)covered if criteria are metApr 27, 2026payer document
AetnaUrological Supplies (0533)listed, no stance (range 56405-58999)Jul 30, 2026payer document

Medicaid fee-for-service

  • AZ: $733.60 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $374.14 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $494.51 (physician, non-facility), effective Jan 1, 2026
  • IL: $496.43 (practitioner), effective Apr 1, 2024
  • IN: $547.07 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $450.00 (asc, facility), effective Aug 1, 1982
  • KY: $296.24 (physician, facility), effective Jan 1, 2026
  • LA: $583.41 (professional), effective Jul 1, 2025
  • MA: $535.26 (physician_surgery), effective May 1, 2024
  • MS: $530.90 (comprehensive), effective Jul 1, 2026
  • ND: $666.12 (physician), effective Aug 1, 2026
  • NE: $170.14 (physician, non-facility), effective Jul 1, 2026
  • NY: $330.52 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $393.29 (physician), effective Jan 1, 2024
  • OK: $560.13 (physician, non-facility), effective Jul 1, 2026
  • TX: $88.91 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2026
  • VA: $642.29 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $369.40 (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.