8 commercial payer policies list 51721. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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8 policies from 7 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of 51721 |
|---|---|---|
| Cigna Commercial Other Services Code List - Effective 03/07/2026 | Mar 7, 2026 | Prior auth required |
| Cigna Comprehensive Code List - Effective 03/07/2026 | Mar 7, 2026 | Prior auth required |
| Policy | Effective | Status of 51721 |
|---|---|---|
| Ultrasound Ablation for Oncologic Indications | Jan 6, 2026 | Covered |
| Policy | Effective | Status of 51721 |
|---|---|---|
| Intensity Modulated Radiation Therapy | Mar 2, 2026 |
| Covered |
| Policy | Effective | Status of 51721 |
|---|---|---|
| Magnetic Resonance (MR) Guided Focused Ultrasound (MRgFUS), and High Intensity Focused Ultrasound (HIFU) Ablation, and Transurethral Ultrasound Ablation (TULSA) | Dec 1, 2025 | Covered |
| Policy | Effective | Status of 51721 |
|---|---|---|
| Prostate Surgeries and Interventions – Surest Medical Policy | Jun 1, 2026 | Covered |
| Policy | Effective | Status of 51721 |
|---|---|---|
| Prostate Surgeries and Interventions | Jun 1, 2026 | Covered |
| Policy | Effective | Status of 51721 |
|---|---|---|
| Prostate Surgeries and Interventions | Jun 1, 2026 | Covered |