10120 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 10120

Payer coverage policies that name 10120

10120 appears in 1 coverage policy from Aetna.

Medicaid fee-for-service

• AZ: $62.08 (asc), effective Oct 1, 2026
• CO: $96.49 (chp_plus, non-facility), effective Jul 1, 2026
• FL: $79.49 (physician, facility), effective Jan 1, 2026
• IL: $39.05 (podiatrist), effective Apr 1, 2024
• IN: $81.93 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
• KS: $195.00 (asc, facility), effective Aug 1, 1982
• KY: $110.75 (asc), effective Jan 1, 2026
• LA: $217.00 (asc), effective Jul 1, 2012
• MA: $90.81 (asc), effective May 1, 2026
• MS: $82.29 (comprehensive, facility), effective Oct 1, 2025
• MT: $103.36 (optometric, facility), effective Jul 1, 2025
• ND: $109.55 (physician, facility), effective Aug 1, 2026
• NE: $79.52 (physician, facility), effective Jul 1, 2026
• NY: $41.06 (nurse_practitioner, facility), effective Jul 1, 2026
• OH: $52.60 (physician, facility), effective Jan 1, 2024
• OK: $101.04 (asc), effective Jan 1, 2026
• TX: $86.38 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
• VA: $88.54 (medical, facility), effective Jul 1, 2026
• VT: $315.64 (outpatient_hospital_opps), effective Feb 1, 2026
• WA: $61.92 (physician, facility), effective Jul 1, 2026
• WY: $179.77 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.