64581 CPT® code: payer coverage and prior authorization36 of 36 payer prior-auth lists that name 64581 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Texas, CarePlus Health Plans, Humana, Medicare, Neighborhood Health Partnership, Oxford Health Plans, Rocky Mountain Health Plans, Surest, UnitedHealthcare, UnitedHealthcare Community Plan.
64581 appears in 37 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, BlueCross BlueShield of South Carolina, Capital Blue Cross, Centene, Premera Blue Cross, Regence, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Chronic Pain Rehabilitation Programs (0237) | listed, no stance (range 64553-64595) | Apr 23, 2026 | payer document |
| Aetna | Chronic Pelvic Pain, Endometriosis, and Other Indications: Selected Treatments (0754) | not covered | Oct 30, 2025 | payer document |
| Aetna | Constraint-Induced Therapy (0665) | listed, no stance (range 64555-64595) | Oct 8, 2026 | payer document |
| Aetna | Fecal Incontinence (0611) | covered if criteria are met | Sep 23, 2026 | payer document |
| Aetna | Functional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677) | covered if criteria are met | Sep 10, 2026 | payer document |
| Aetna | Intraoperative Neurophysiological Monitoring (0697) | not covered | Jun 19, 2026 | payer document |
| Aetna | Intravenous Iron Therapy (0575) | listed, no stance (range 61000-64999) | Jul 1, 2026 | payer document |
| Aetna | Pelvic Congestion Syndrome Treatments (0441) | not covered | Jul 9, 2026 | payer document |
| Aetna | Peripheral Electrical Nerve Stimulation for Pain (0011) | not covered | Jun 3, 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 | Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (0703) | listed, no stance (range 61000-64999) | Nov 24, 2025 | payer document |
| Aetna | Urinary Incontinence (0223) | covered if criteria are met | Jul 16, 2026 | payer document |
| Aetna | Vulvodynia and Vulvar Vestibulitis Treatments (0759) | not covered | Nov 12, 2025 | payer document |
| Anthem | Sacral Nerve Stimulation for Urinary Retention, Urinary Incontinence, and Fecal Incontinence (CG-SURG-95) | covered if criteria are met | Aug 13, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Sacral Nerve Neuromodulationstimulation | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Temporomandibular Joint Disorder | not covered | payer document | |
| Blue Cross Blue Shield of Massachusetts | Sacral Nerve Neuromodulation and Stimulation (153) | listed, no stance | payer document | |
| Blue Cross NC | Sacral Nerve Neuromodulation/Stimulation for Pelvic Floor Dysfunction | listed, no stance | Nov 1, 2025 | payer document |
| BlueCross BlueShield of South Carolina | Sacral Nerve Neuromodulation/Stimulation (CAM 70169) | listed, no stance | Jun 1, 2026 | payer document |
| Capital Blue Cross | Sacral Nerve Neuromodulation-Stimulation (MP 1.033) Procedure codes | covered if criteria are met | May 1, 2026 | payer document |
| Centene | Fecal Incontinence Treatments (CP.MP.137) | covered if criteria are met | May 1, 2026 | payer document |
| Centene | Urinary Incontinence Devices and Treatments Reference Number: CP.MP.142 (CP.MP.142) | covered if criteria are met | Nov 1, 2025 | payer document |
| Premera Blue Cross | Sacral Nerve Neuromodulation/Stimulation (7.01.69) | listed, no stance | Jun 8, 2026 | payer document |
| Regence | Sacral Nerve Neuromodulation (Stimulation) for Pelvic Floor Dysfunction (Surgery 134) | listed, no stance | Oct 1, 2025 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (2026T0630J) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (CS358.E) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (for Idaho Only) (CS358ID.B) | listed, no stance | May 1, 2026 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (for Kansas Only) (CS358KS.02) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (for Kentucky Only) (CS358KY.05) | listed, no stance | Apr 1, 2026 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (for Nebraska Only) (CS358NE.E) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (for New Jersey Only) (CS358NJ.E) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (for New Mexico Only) (CS358NM.D) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (for North Carolina Only) (CSNCT0358.02) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (for Ohio Only) (CS358OH.E) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (for Pennsylvania Only) (CS258PA.E) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Sacral Nerve Stimulation for Urinary and Fecal Indications (for Tennessee Only) (CS358TN.E) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Urinary and Fecal Incontinence: Diagnosis and Treatment (MMP049.14) Sacral Nerve Stimulation (SNS) for Fecal Incontinence | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in VA, VT, WA, WV, WY.
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.