97597 CPT® code: payer coverage and prior authorization5 of 5 payer prior-auth lists that name 97597 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Shield of California, Humana, Rocky Mountain Health Plans, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Shield of California | Blue Shield commercial | CA | prior auth under conditions | CalPERS ASO only | Sep 1, 2026 | Prior Authorization List for Blue Shield |
| Blue Cross and Blue Shield of Illinois | Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative) | IL | prior auth required | eviCore-managed | Jan 1, 2020 | Procedure Code List, Effective 1/1/2025 |
| Humana | Humana Healthy Horizons | KY | prior auth required | Jan 1, 2027 | please visit Humana Healthy Horizons in Kentucky Clinical coverage policies. | |
| 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 | |
| UnitedHealthcare Community Plan | New Jersey FamilyCare | NJ | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of New Jersey Effective October 1, 2026 General Information This list contains prior authorization requirements for participating U |
97597 appears in 14 coverage policies from Aetna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 97010-97799) | Oct 6, 2026 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 97010-97763) | Oct 6, 2026 | payer document |
| Aetna | Chiropractic Services (0107) | listed, no stance (range 97010-97799) | Apr 7, 2026 | payer document |
| Aetna | Electrical Stimulation for Chronic Ulcers (0680) | listed, no stance | Dec 29, 2025 | payer document |
| Aetna | Electrodiagnostic Testing (0502) | listed, no stance (range 97010-97799) | Jul 29, 2026 | payer document |
| Aetna | Functional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677) | listed, no stance (range 97010-97763) | Sep 10, 2026 | payer document |
| Aetna | Home Health Aides (0218) | listed, no stance (range 97010-97799) | Sep 10, 2026 | payer document |
| Aetna | Knee Arthroplasty (0660) | listed, no stance (range 97010-97799) | Oct 8, 2026 | payer document |
| Aetna | Negative Pressure Wound Therapy (0334) | listed, no stance (range 97597-97598) | Jun 8, 2026 | payer document |
| Aetna | Skin and Soft Tissue Substitutes (0244) | listed, no stance | Jul 29, 2026 | payer document |
| Aetna | Standing Frames, Tables, and Transfer Boards (0481) | listed, no stance (range 97001-97763) | Jul 2, 2026 | payer document |
| Aetna | Surgical Devices, Dressings, and Wound Care Supplies (0526) | covered if criteria are met | Aug 26, 2026 | payer document |
| Aetna | Total Ankle Arthroplasty (0645) | listed, no stance (range 97001-97799) | Sep 14, 2026 | payer document |
| Aetna | Vasectomy Procedures and Chronic Scrotal Content Pain (0027) | listed, no stance (range 97010-97799) | Jan 27, 2026 | payer document |
| Aetna | Wound Care: Home or Outpatient Setting (1054) | listed, no stance (range 97597-97610) | Dec 23, 2025 | payer document |
Prior authorization required or conditional in WV.
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.