S2112 Knee arthroscp harv

Payer policies and prior authorization for S2112

30 of 30 payer prior-auth lists that name S2112 require prior authorization or set conditions: Aetna, Blue Cross and Blue Shield of Texas, Humana, Neighborhood Health Partnership, Oxford Health Plans, Rocky Mountain Health Plans, Surest, UnitedHealthcare, UnitedHealthcare Community Plan.

Payer coverage policies that name S2112

S2112 appears in 17 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, Regence, UnitedHealthcare.

Medicaid fee-for-service

Prior authorization required or conditional in IN.

• CO: $1698.18 (health_first_colorado), effective Jul 1, 2026
• ND: $0.00 (physician), effective Aug 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.