`93451` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 93451

36 of 42 payer prior-auth lists that name 93451 require prior authorization or set conditions: Aetna, CarePlus Health Plans, Cigna, Humana, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Molina Healthcare of Washington, Rocky Mountain Health Plans.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Aetna	Medicare Advantage	All	prior auth required	Not required for Student Health or Allina Health \| Aetna plans	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth required	Not required for Student Health or Allina Health \| Aetna plans	Oct 1, 2026	Participating provider precertification list for Aetna®
Cigna	ACA/IFP	All	prior auth required	May be delegated to eviCore for some clients	Feb 17, 2014	Master Precertification List (For Health Care Providers)
Cigna	Cardiology	All	prior auth required		Mar 7, 2026	Cigna Commercial Prior Authorization Procedure Code List: Cardiology
Cigna	Cardiology	All	prior auth required		Mar 7, 2026	Cigna Commercial Comprehensive CPT Code Reference for Prior Authorization Across All Programs
Cigna	Complete/PHS+/Preferred	All	prior auth required	May be delegated to eviCore for some clients	Feb 17, 2014	Master Precertification List (For Health Care Providers)
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth required		Jan 1, 2027	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Humana	Cardiology Services	All	prior auth required			Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
Humana	Cardiology Services	All	prior auth required			Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
Humana	Cardiology Services	All	prior auth required			Humana Prior Authorization List (PAL): Cardiovascular and Endoscopy Services
Humana	Humana D-SNP (FL)	FL	prior auth required		Jan 1, 2027	1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
Humana	Humana D-SNP (IL)	IL	prior auth required		Jan 1, 2027	Humana Dual Fully Integrated Illinois Prior Authorization and Notification List
Humana	Humana D-SNP (IN)	IN	prior auth required		Jan 1, 2027	*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
Humana	Humana D-SNP (MI)	MI	prior auth required		Jan 1, 2027	1 Humana Dual Highly Integrated Michigan Prior Authorization and Notification List
Humana	Humana D-SNP (SC)	SC	prior auth required		Jan 1, 2027	Humana Dual Highly Integrated South Carolina Prior Authorization and Notification List
Humana	Humana D-SNP (VA)	VA	prior auth required		Jan 1, 2027	Virginia Prior Authorization and Notification List
Humana	Humana Healthy Horizons	IL	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Illinois Prior Authorization and Notification List To view -specific medical coverage policies, please visit Humana Healthy Horizons in Illinois Clinical coverage policies .
Humana	Humana Healthy Horizons	KY	prior auth required		Jan 1, 2027	please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.
Humana	Humana Healthy Horizons	OK	prior auth required		Jan 1, 2027	Humana Healthy Horizons® in Oklahoma Prior Authorization Notification List (PAL) The following preauthorization and notification list
Humana	Humana Healthy Horizons	VA	prior auth required		Jan 1, 2027	Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
Humana	Humana MA and D-SNP	All	prior auth required		Jan 1, 2027	Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
Humana	Oak Street Health	All	prior auth required			Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Molina Healthcare of California	Medicaid	CA	prior auth required		Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of California	Medicare Advantage	CA	prior auth required		Jul 1, 2021	Medicare Prior Auth (PA) Code Matrix (California), effective Q3 2021
Molina Healthcare of Florida	Medicare Advantage	FL	prior auth required	vendor review only eviCore in IL/MI/OH/NY/WI	Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021
Molina Healthcare of Idaho	Medicare Advantage	ID	prior auth required	vendor review only eviCore in IL/MI/OH/NY/WI	Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021
Molina Healthcare of Illinois	Medicaid	IL	prior auth required		Apr 1, 2023	Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of Michigan	Medicare Advantage	MI	prior auth required	adults via Evolent	Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Michigan	Medicaid	MI	prior auth under conditions	adults via Evolent; no PA for pediatrics	Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Michigan	Exchange	MI	prior auth required	Contact eviCore for PA	Jul 1, 2021	Molina Healthcare of Michigan PA Matrix, effective 7/1/2021
Molina Healthcare of Ohio	Medicaid and MyCare Ohio (MMP) Medicaid	OH	prior auth under conditions	no PA under 18	Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Exchange	OH	prior auth under conditions	no PA under 18	Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Texas	Exchange	TX	prior auth required		Jul 1, 2021	Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026
Molina Healthcare of Utah	Medicare Advantage	UT	prior auth required	vendor review only eviCore in IL/MI/OH/NY/WI	Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021
Molina Healthcare of Washington	Medicare Advantage	WA	prior auth required	vendor review only eviCore in IL/MI/OH/NY/WI	Apr 1, 2021	Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021
Rocky Mountain Health Plans	Rocky Mountain Medicare Advantage D-SNP	CO	prior auth required		Feb 1, 2025	Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025

Payer coverage policies that name 93451

93451 appears in 5 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Enhanced External Counterpulsation (EECP) (0262)	listed, no stance	May 14, 2026	payer document
Aetna	Heart Transplantation (0586)	listed, no stance (range 93451-93454)	Sep 11, 2026	payer document
Aetna	Inpatient Admission Prior to Surgery (Preop Days) (0255)	listed, no stance (range 93451-93454)	May 13, 2026	payer document
Aetna	Lung Transplantation (0598)	listed, no stance	Sep 8, 2026	payer document
Aetna	Nerve Blocks (0863)	listed, no stance (range 92920-93799)	Jul 23, 2026	payer document

Recent prior-auth changes

Jan 1, 2027: PA added, Humana
Jul 1, 2026: PA removed, HealthSpring
Mar 1, 2025: PA removed, Rocky Mountain Health Plans
Mar 1, 2025: PA removed, Rocky Mountain Health Plans
Jul 1, 2024: conditions changed, Molina Healthcare of Illinois
Jan 1, 2024: conditions changed, Molina Healthcare of Michigan
Jun 1, 2023: PA removed, Blue Shield of California Promise Health Plan
Jan 1, 2023: PA removed, Molina Healthcare of Ohio
Oct 1, 2021: PA removed, Molina Healthcare of Wisconsin
Oct 1, 2021: PA removed, Molina Healthcare, Inc. (national grid)

Medicaid fee-for-service

AZ: $1188.48 (asc), effective Oct 1, 2026
CO: $646.14 (chp_plus, non-facility), effective Jul 1, 2026
FL: $99.49 (physician), effective Jan 1, 2026
IL: $542.98 (practitioner), effective Apr 1, 2024
IN: $620.60 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
KS: $1042.26 (asc, facility), effective Jan 1, 2021
KY: $1667.03 (asc), effective Jan 1, 2026
LA: $154.60 (professional), effective Feb 1, 2013
MA: $1168.21 (asc), effective May 1, 2026
MS: $1324.57 (comprehensive, facility), effective Oct 1, 2025
ND: $982.71 (physician, facility), effective Aug 1, 2026
NE: $162.32 (physician, non-facility), effective Jul 1, 2026
NY: $370.63 (physician_medicine, facility), effective Jul 1, 2026
OH: $467.19 (physician), effective Jan 1, 2024
OK: $718.40 (physician, non-facility), effective Jul 1, 2026
TX: $687.65 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, non-facility), effective Sep 1, 2025
VA: $737.56 (medical), effective Jul 1, 2026
VT: $2517.23 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $531.45 (physician, facility), effective Jul 1, 2026
WY: $1433.70 (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.

93451 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 93451

Payer coverage policies that name 93451

Recent prior-auth changes

Medicaid fee-for-service

`93451` CPT® code: payer coverage and prior authorization