63052 CPT® code: payer coverage and prior authorization42 of 43 payer prior-auth lists that name 63052 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, CarePlus Health Plans, Humana, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Idaho, 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 Texas, Passport by Molina Healthcare (Kentucky).
63052 appears in 21 coverage policies from Aetna, BlueCross BlueShield of South Carolina, Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 63001-63091) | Oct 6, 2026 | payer document |
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | covered if criteria are met (range 63001-63053) | Jun 19, 2026 | payer document |
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | not covered (range 62263-63746) | Jun 19, 2026 | payer document |
| Aetna | Intravenous Iron Therapy (0575) | listed, no stance (range 61000-64999) | Jul 1, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | listed, no stance (range 62263-63746) | Jul 23, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | listed, no stance | Jul 23, 2026 | payer document |
| Aetna | Respiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479) | listed, no stance (range 61000-64999) | Jul 9, 2026 | payer document |
| Aetna | Spinal Surgery: Laminectomy and Fusion (0743) | covered if criteria are met | Jul 30, 2026 | payer document |
| Aetna | Spinal Surgery: Laminectomy and Fusion (0743) | listed, no stance | Jul 30, 2026 | payer document |
| Aetna | Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (0703) | listed, no stance (range 61000-64999) | Nov 24, 2025 | payer document |
| BlueCross BlueShield of South Carolina | Lumbar Spinal Procedures (CAM 161) | listed, no stance | Jul 1, 2026 | payer document |
| Premera Blue Cross | Lumbar Spinal Fusion in Adults (7.01.542) Page | 10 of 39 | ∞ | listed, no stance | Jun 1, 2026 | payer document |
| Regence | Lumbar Spinal Fusion (Surgery 187) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (CS365.E) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (2026T0639J) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Idaho Only) (CS365ID.D) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Kansas Only) (CS365KS.02) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Kentucky Only) (CS365KY.05) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for New Jersey Only) (CS365NJ.E) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for New Mexico Only) (CS365NM.C) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Ohio Only) (CS365OH.D) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Pennsylvania Only) (CS365PA.E) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Spinal Fusion and Decompression (for Tennessee Only) (CS365TN.E) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | This Medical Policy only applies to the State of Nebraska. (CS365NE.E) | listed, no stance | May 1, 2026 | payer document |
Prior authorization required or conditional in WA.
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.