11047 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 11047

Payer coverage policies that name 11047

11047 appears in 7 coverage policies from Aetna, Centene.

PayerPolicyRole in policyReviewedDocument
AetnaElectrical Stimulation for Chronic Ulcers (0680)listed, no stance (range 11042-11047)Dec 29, 2025payer document
AetnaHammertoe Repair (0636)listed, no stance (range 11044-11047)Sep 11, 2026payer document
AetnaHypertrophic Scars and Keloids (0389)listed, no stance (range 11042-11047)May 28, 2026payer document
AetnaNegative Pressure Wound Therapy (0334)listed, no stance (range 11000-11047)Jun 8, 2026payer document
AetnaSkin and Soft Tissue Substitutes (0244)listed, no stanceJul 29, 2026payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 10040-19499)Jul 29, 2026payer document
AetnaWound Care: Home or Outpatient Setting (1054)listed, no stance (range 11000-11047)Dec 23, 2025payer document
CenteneBurn Surgery (CP.MP.186)covered if criteria are metNov 1, 2025payer document

Medicaid fee-for-service

  • AZ: $25.11 (outpatient_hospital, RF133), effective Oct 1, 2025
  • CO: $75.60 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $66.41 (physician, facility), effective Jan 1, 2026
  • IN: $72.91 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $202.67 (asc, facility), effective Jan 1, 2011
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $97.30 (professional), effective Jul 1, 2025
  • MA: $0.00 (asc), effective May 1, 2026
  • MS: $72.07 (comprehensive), effective Jul 1, 2026
  • ND: $136.68 (physician), effective Aug 1, 2026
  • NE: $413.00 (asc), effective Jul 1, 2024
  • NY: $25.83 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $49.32 (physician, facility), effective Jan 1, 2024
  • OK: $75.83 (physician, facility), effective Jul 1, 2026
  • TX: $70.82 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2025
  • VA: $73.78 (medical, facility), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $48.92 (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.