93595 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 93595

25 of 32 payer prior-auth lists that name 93595 require prior authorization or set conditions: Aetna, CarePlus Health Plans, Humana, Molina Healthcare of Ohio, Neighborhood Health Partnership, Rocky Mountain Health Plans, Surest, UnitedHealthcare.

PayerPlanStatePrior authConditionsSinceSource
AetnaMedicare AdvantageAllprior auth requiredNot required for Student Health or Allina Health | Aetna plansOct 1, 2026Participating provider precertification list for Aetna®
AetnaCommercialAllprior auth requiredNot required for Student Health or Allina Health | Aetna plansOct 1, 2026Participating provider precertification list for Aetna®
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 Healthy HorizonsILprior auth requiredJan 1, 2027Humana 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 .
HumanaHumana Healthy HorizonsKYprior auth requiredJan 1, 2027please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.
HumanaHumana Healthy HorizonsVAprior auth requiredJan 1, 2027Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
HumanaHumana MA and D-SNPAllprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Molina Healthcare of OhioMedicaid and MyCare Ohio (MMP) MedicaidOHprior auth under conditionsno PA under 18Oct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of OhioExchangeOHprior auth under conditionsno PA under 18Oct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Neighborhood Health PartnershipNeighborhood Health PartnershipFLprior auth under conditionsonly with dx I27.83, Q20.0, Q20.1, Q20.2, Q20.3, Q20.4Sep 1, 2026Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026
Rocky Mountain Health PlansRocky Mountain Medicare Advantage D-SNPCOprior auth requiredFeb 1, 2025Rocky Mountain Health Plans Medicare Advantage Dual-Special Needs Plans – prior authorization Effective February 1, 2025
SurestSurest health plansAllprior auth requiredOct 1, 2026Prior Authorization Requirements for Surest Effective October 1, 2026
UnitedHealthcareUnitedHealthcare CommercialAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth requiredSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Individual Exchange plansAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026

Payer coverage policies that name 93595

93595 appears in 2 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaEnhanced External Counterpulsation (EECP) (0262)listed, no stanceMay 14, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 92920-93799)Jul 23, 2026payer document

Recent prior-auth changes

  • Jan 1, 2027: PA added, Humana
  • Jul 1, 2026: PA removed, HealthSpring
  • Jan 1, 2026: PA removed, Molina Healthcare of Illinois
  • Jan 1, 2026: PA removed, Molina Healthcare of Michigan
  • Oct 1, 2025: conditions changed, UnitedHealthcare
  • May 30, 2025: PA removed, Cigna
  • May 30, 2025: PA removed, Cigna
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans
  • Mar 1, 2025: PA removed, Rocky Mountain Health Plans
  • Jan 1, 2025: PA removed, UnitedHealthcare

Medicaid fee-for-service

  • AZ: $2101.79 (outpatient_hospital), effective Oct 1, 2023
  • CO: $230.18 (health_first_colorado), effective Jul 1, 2026
  • FL: $9.89 (physician), effective Jan 1, 2026
  • IL: $171.58 (practitioner), effective Apr 1, 2024
  • IN: $202.28 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $419.86 (default, Exempt Physician), effective Jan 1, 2022
  • KY: $0.00 (physician, facility), effective Jan 1, 2026
  • LA: $199.22 (professional), effective Jan 1, 2022
  • MA: $193.85 (physician_medicine), effective May 1, 2024
  • MS: $217.96 (comprehensive), effective Jul 1, 2026
  • ND: $0.00 (physician), effective Aug 1, 2026
  • NE: $603.77 (physician, non-facility), effective Jul 1, 2026
  • NY: $0.00 (physician_medicine, facility), effective Jul 1, 2026
  • OK: $228.76 (physician, non-facility), effective Jul 1, 2026
  • TX: $541.31 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, non-facility), effective Sep 1, 2025
  • VA: $0.00 (medical), effective Sep 1, 2026
  • VT: $2517.23 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $150.59 (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.