A4558 Conductive gel or pasteConductive gel or paste, for use with electrical device (e.g., tens, nmes), per oz
Status P: bundled or excluded, no separate PFS payment.
1 of 1 payer prior-auth lists that name A4558 require prior authorization or set conditions: Rocky Mountain Health Plans.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| 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 |
A4558 appears in 11 coverage policies from Aetna, BlueCross BlueShield of South Carolina, Capital Blue Cross.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Functional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677) | covered if criteria are met | Sep 10, 2026 | payer document |
| Aetna | Headaches: Invasive Procedures (0707) | not covered | Jul 23, 2026 | payer document |
| Aetna | Multiple Sclerosis (0264) Serum neurofilament, Osteopontin, Clemastine fumarate, Intravesical vanilloids, cannabis and cannabinoids | not covered | Sep 10, 2026 | payer document |
| Aetna | Organ Prolapse: Selected Procedures (0858) | not covered | Dec 24, 2025 | payer document |
| Aetna | Peripheral Electrical Nerve Stimulation for Pain (0011) | covered if criteria are met | Jun 3, 2026 | payer document |
| Aetna | Spasticity Management (0362) | not covered | May 26, 2026 | payer document |
| Aetna | Temporomandibular Disorders (0028) | not covered | Mar 12, 2026 | payer document |
| Aetna | Transcranial Magnetic Stimulation and Cranial Electrical Stimulation (0469) | not covered | Jul 17, 2026 | payer document |
| Aetna | Trigeminal Neuralgia: Treatments (0374) Topical ambroxol, Erenumab, Intravenous ketamine | not covered | Jun 29, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Neuromuscular Electrical Stimulation (NMES) (CAM 014) | listed, no stance | Sep 1, 2026 | payer document |
| Capital Blue Cross | Transcutaneous Electrical Nerve Stimulation and Transcutaneous Afferent Patterned Stimulation (MP 6.020) Procedure codes | covered if criteria are met | Apr 1, 2026 | payer document |
Prior authorization required or conditional in MA, OH, VA.
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.