Payer policies › CPT 1003610036 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 10036 Medicaid fee-for-service Prior authorization required or conditional in KY.
AZ: $247.55 (outpatient_hospital, RF133), effective Oct 1, 2025 CO: $38.90 (chp_plus, non-facility), effective Jul 1, 2026 FL: $28.95 (physician, facility), effective Jan 1, 2026 IL: $28.14 (practitioner), effective Apr 1, 2024 IN: $32.56 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $128.68 (default, Exempt Physician), effective Aug 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $381.30 (professional), effective Jan 1, 2016 MA: $0.00 (asc), effective May 1, 2026 MS: $31.54 (comprehensive), effective Jul 1, 2026 ND: $324.05 (physician), effective Aug 1, 2026 NE: $66.68 (physician, non-facility), effective Jul 1, 2026 NY: $24.17 (physician_surgery, facility), effective Jul 1, 2026 OH: $35.34 (physician, facility), effective Jan 1, 2024 OK: $33.10 (physician, facility), effective Jul 1, 2026 TX: $33.41 (physician, Physician, facility), effective Mar 1, 2021 VA: $31.83 (medical, facility), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $21.21 (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.