Payer policies › CPT 0195801958 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 01958 Payer coverage policies that name 01958 01958 appears in 2 coverage policies from Anthem, BlueCross BlueShield of South Carolina.
Payer Policy Role in policy Reviewed Document Anthem Anesthesia Services and Moderate (“Conscious”) Sedation (CG-MED-21) covered if criteria are met (range 01958-01969) Nov 6, 2025 payer document BlueCross BlueShield of South Carolina Maternity/Obstetrical Care Benefits (CAM 366) listed, no stance Feb 1, 2026 payer document
Medicaid fee-for-service AZ: $32.12 (anesthesia), effective Oct 1, 2026 CO: $16.98 (chp_plus, non-facility), effective Jul 1, 2026 FL: $82.33 (physician, non-facility), effective Jan 1, 2026 IN: $0.00 (professional, facility), effective Jan 1, 2004 MA: $5.00 (anesthesia), effective Aug 1, 2021 MS: $5.00 (anesthesia), effective Jan 1, 2004 NY: $5.00 (physician_anesthesia), effective Apr 1, 2026 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $5.00 (certified_registered_nurse_anesthetist_crna_anesthesiologist, Certified Registered Nurse Anesthetist (Crna) / Anesthesiologist Assistant (Aa), facility), effective Nov 1, 2017 VA: $4.00 (medical), effective Jan 1, 2004 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $5.00 (physician, facility), effective Jul 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.