64416 CPT® code: payer coverage and prior authorization2 of 2 payer prior-auth lists that name 64416 require prior authorization or set conditions: UnitedHealthcare, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth required | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 | |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Kentucky | KY | prior auth required | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026 |
64416 appears in 13 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Capital Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Bupivacaine Liposome (Exparel) (0941) | listed, no stance | Jul 30, 2026 | payer document |
| Aetna | Complex Regional Pain Syndrome (CRPS): Treatments (0447) | listed, no stance (range 64400-64455) | Jul 16, 2026 | payer document |
| Aetna | Diabetic Neuropathy: Selected Treatments (0729) | not covered | Feb 24, 2026 | payer document |
| Aetna | Infusion Pumps (0161) | covered if criteria are met (range 64400-64530) | Mar 31, 2026 | payer document |
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | covered if criteria are met | 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) | covered if criteria are met (range 64400-64450) | Jul 23, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | covered if criteria are met | Jul 23, 2026 | payer document |
| Aetna | Nerve Blocks (0863) | covered if criteria are met (range 64415-64416) | 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 Ultrasound (0628) | listed, no stance (range 64400-64530) | Sep 11, 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 |
| Aetna | Ultrasound Guidance – Selected Indications (0952) | covered if criteria are met | Apr 27, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Postoperative Pain Management (L.7.02.401) | not covered | payer document | |
| Capital Blue Cross | Neural Therapy (MP 8.012) Procedure codes | unproven / investigational | Feb 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.