70558 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 70558

1 of 1 payer prior-auth lists that name 70558 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue).

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)Federal Employee Program (FEP)AZprior auth under conditionsFEP Blue Focus onlySep 1, 2026Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)

Payer coverage policies that name 70558

70558 appears in 1 coverage policy from Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
Premera Blue CrossComputerized Diagnostic Imaging for Complex Maxillofacial Procedures
Page | 4 of 8 | ∞
listed, no stanceJun 22, 2026payer document

Medicaid fee-for-service

Prior authorization required or conditional in FL, KY, WV.

  • AZ: $69.76 (asc), effective Oct 1, 2026
  • CO: $135.42 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $104.88 (radiology), effective Jan 1, 2026
  • IL: $87.53 (practitioner), effective Jul 1, 2026
  • IN: $131.30 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $101.80 (default, Exempt Physician), effective Jan 1, 2024
  • KY: $94.95 (asc), effective Jan 1, 2026
  • MA: $142.42 (physician_radiology), effective May 1, 2024
  • MS: $77.37 (comprehensive, facility), effective Oct 1, 2025
  • ND: $0.00 (physician), effective Aug 1, 2026
  • NY: $505.00 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $488.64 (physician), effective Jan 1, 2018
  • OK: $86.62 (asc), effective Jan 1, 2026
  • TX: $139.21 (physician, Physician, facility), effective Mar 1, 2025
  • VA: $146.99 (medical), effective Jul 1, 2026
  • VT: $136.19 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $101.47 (physician, facility), effective Jul 1, 2026
  • WY: $77.57 (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.