C7571 Pcta w/ cor lithotrip

Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with percutaneous transluminal coronary lithotripsy

Payer policies and prior authorization for C7571

11 of 11 payer prior-auth lists that name C7571 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
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 MA and D-SNPAllprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List

Payer coverage policies that name C7571

C7571 appears in 4 coverage policies from Aetna, Blue Shield of California, Premera Blue Cross, Regence.

PayerPolicyRole in policyReviewedDocument
AetnaCoronary Artery Brachytherapy and Other Adjuncts to Coronary Interventions (0491)not coveredJul 30, 2026payer document
Blue Shield of CaliforniaBSC2.13 Elective Invasive Coronary Angiography (ICA)listed, no stancepayer document
Premera Blue CrossPercutaneous Coronary Intervention, Angioplasty, Non-Emergent in Adults (2.02.508)listed, no stanceAug 11, 2026payer document
RegenceIntravascular Lithotripsy (Surgery 233)listed, no stanceDec 1, 2025payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

  • AZ: $3579.24 (asc), effective Oct 1, 2026
  • ND: $3764.30 (physician, facility), effective Aug 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 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.