11626 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 11626

Payer coverage policies that name 11626

11626 appears in 2 coverage policies from Aetna, Regence.

PayerPolicyRole in policyReviewedDocument
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 10040-19499)Jul 29, 2026payer document
RegenceSurgical Site of Care – Hospital Outpatient (Utilization Management 19)listed, no stanceMay 1, 2026payer document

Medicaid fee-for-service

  • AZ: $751.83 (asc), effective Oct 1, 2026
  • CO: $280.28 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $415.42 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IL: $199.23 (practitioner), effective Apr 1, 2024
  • IN: $222.44 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $300.00 (asc, facility), effective Aug 1, 1982
  • KY: $1218.59 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $845.19 (asc), effective May 1, 2026
  • MS: $961.52 (comprehensive, facility), effective Oct 1, 2025
  • ND: $718.36 (physician, facility), effective Aug 1, 2026
  • NE: $552.00 (asc), effective Jul 1, 2024
  • NY: $135.80 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $161.41 (physician, facility), effective Jan 1, 2024
  • OK: $1111.74 (asc), effective Jan 1, 2026
  • TX: $815.20 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $220.20 (medical, facility), effective Jul 1, 2026
  • VT: $2255.40 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1284.57 (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.