64656 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 64656

12 of 12 payer prior-auth lists that name 64656 require prior authorization or set conditions: CarePlus Health Plans, Humana, UnitedHealthcare.

PayerPlanStatePrior authConditionsSinceSource
CarePlus Health PlansCarePlus Health PlansFLprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaCardiology ServicesAllprior auth requiredHumana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
HumanaCardiology ServicesAllprior auth requiredHumana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
HumanaCardiology ServicesAllprior auth requiredHumana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
HumanaHumana D-SNP (FL)FLprior auth requiredJan 1, 20271 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
HumanaHumana D-SNP (IL)ILprior auth requiredJan 1, 2027Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
HumanaHumana D-SNP (IN)INprior auth requiredJan 1, 2027*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
HumanaHumana D-SNP (MI)MIprior auth requiredJan 1, 20271 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
HumanaHumana D-SNP (SC)SCprior auth requiredJan 1, 2027Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
HumanaHumana D-SNP (VA)VAprior auth requiredJan 1, 2027Virginia Prior Authorization and Notification List
HumanaHumana MA and D-SNPAllprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
UnitedHealthcareUnitedHealthcare Medicare Advantage, Peoples Health and Dual Complete (D-SNP)Allprior auth requiredOct 1, 2026UnitedHealthcare® Medicare Advantage/ Peoples Health Plans prior authorization requirements Effective October 1, 2026

Payer coverage policies that name 64656

64656 appears in 13 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Cross NC, Blue Shield of California, Regence, UnitedHealthcare.

PayerPolicyRole in policyReviewedDocument
AetnaCarotid Sinus Stimulation for Hypertension and Heart Failure (0820)not coveredApr 7, 2026payer document
AetnaIntraoperative Neurophysiological Monitoring (0697)not covered (range 64650-64681)Jun 19, 2026payer document
AetnaIntravenous Iron Therapy (0575)listed, no stance (range 61000-64999)Jul 1, 2026payer document
AetnaRespiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479)listed, no stance (range 61000-64999)Jul 9, 2026payer document
AetnaThermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (0703)listed, no stance (range 61000-64999)Nov 24, 2025payer document
AnthemCarotid Sinus Baroreceptor Stimulation Devices (SURG.00124)unproven / investigationalFeb 19, 2026payer document
Blue Cross & Blue Shield of MississippiBaroreflex Stimulation Devicesunproven / investigationalpayer document
Blue Cross & Blue Shield of Rhode IslandBaroreflex Stimulation Devices
MEDICAL COVERAGE POLICY | 2
not coveredSep 2, 2026payer document
Blue Cross Blue Shield of MassachusettsBaroreflex Stimulation Device (595)unproven / investigationalpayer document
Blue Cross NCBaroreflex Stimulation Deviceslisted, no stanceOct 1, 2025payer document
Blue Shield of California| Baroreflex Stimulation Devices (8.01.57)listed, no stancepayer document
RegenceBaroreflex Stimulation Devices (Surgery 183)listed, no stanceDec 1, 2025payer document
UnitedHealthcareOmnibus Codes (MMP107.09)
performed) | Policy titled
listed, no stanceJun 1, 2026payer document

Recent prior-auth changes

  • Sep 1, 2026: PA added, UnitedHealthcare

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • AZ: $26930.40 (asc), effective Oct 1, 2026
  • IL: $319.40 (practitioner), effective Jan 1, 2026
  • ND: $15862.35 (physician, facility), effective Aug 1, 2026
  • OH: $335.67 (code_changes), effective Jan 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WY: $13646.41 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.