97552 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 97552

12 of 12 payer prior-auth lists that name 97552 require prior authorization or set conditions: CarePlus Health Plans, Humana.

PayerPlanStatePrior authConditionsSinceSource
CarePlus Health PlansCarePlus Health PlansFLprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List
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
HumanaMusculoskeletalAllprior auth requiredHumana Prior Authorization List (PAL): Musculoskeletal Services
HumanaMusculoskeletalAllprior auth requiredHumana Prior Authorization List (PAL): Musculoskeletal Services
HumanaMusculoskeletalAllprior auth requiredHumana Prior Authorization List (PAL): Musculoskeletal Services
HumanaOak Street HealthAllprior auth requiredOak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management

Payer coverage policies that name 97552

97552 appears in 9 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaBack Pain - Invasive Procedures (0016)listed, no stance (range 97010-97799)Oct 6, 2026payer document
AetnaBack Pain - Invasive Procedures (0016)listed, no stance (range 97010-97763)Oct 6, 2026payer document
AetnaChiropractic Services (0107)listed, no stance (range 97010-97799)Apr 7, 2026payer document
AetnaElectrodiagnostic Testing (0502)listed, no stance (range 97010-97799)Jul 29, 2026payer document
AetnaFunctional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677)listed, no stance (range 97010-97763)Sep 10, 2026payer document
AetnaHome Health Aides (0218)listed, no stance (range 97010-97799)Sep 10, 2026payer document
AetnaKnee Arthroplasty (0660)listed, no stance (range 97010-97799)Oct 8, 2026payer document
AetnaStanding Frames, Tables, and Transfer Boards (0481)listed, no stance (range 97001-97763)Jul 2, 2026payer document
AetnaTotal Ankle Arthroplasty (0645)listed, no stance (range 97001-97799)Sep 14, 2026payer document
AetnaVasectomy Procedures and Chronic Scrotal Content Pain (0027)listed, no stance (range 97010-97799)Jan 27, 2026payer document

Recent prior-auth changes

  • Jan 1, 2024: PA added, humana:pa:commercial

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • AZ: $12.20 (outpatient_hospital, RF133), effective Oct 1, 2025
  • KY: $5.85 (occupational_therapy, therapist, facility), effective Jan 1, 2026
  • MA: $17.31 (physician_medicine), effective May 1, 2024
  • ND: $0.00 (physician), effective Aug 1, 2026
  • NE: $10.96 (physician, non-facility), effective Jul 1, 2026
  • OH: $16.56 (physician), effective Jan 1, 2024
  • VA: $8.10 (medical, facility), effective Jul 1, 2026
  • VT: $7.78 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $5.54 (habilitative, facility), effective Jul 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.