12015 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 12015

Payer coverage policies that name 12015

12015 appears in 2 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaBone and Tendon Graft Substitutes and Adjuncts (0411)listed, no stance (range 12001-12021)Aug 18, 2026payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 10040-19499)Jul 29, 2026payer document

Medicaid fee-for-service

  • AZ: $64.28 (asc), effective Oct 1, 2026
  • CO: $89.81 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $70.14 (physician, facility), effective Jan 1, 2026
  • IL: $95.76 (practitioner), effective Apr 1, 2024
  • IN: $70.68 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $324.00 (asc, facility), effective Aug 1, 1982
  • KY: $107.60 (asc), effective Jan 1, 2026
  • LA: $184.81 (professional), effective Feb 1, 2013
  • MA: $75.05 (asc), effective May 1, 2026
  • MS: $85.42 (comprehensive, facility), effective Oct 1, 2025
  • MT: $90.55 (optometric, facility), effective Jul 1, 2025
  • ND: $63.43 (physician, facility), effective Aug 1, 2026
  • NE: $124.06 (physician, facility), effective Jul 1, 2026
  • NY: $80.86 (nurse_practitioner, facility), effective Jul 1, 2026
  • OH: $71.78 (physician, facility), effective Jan 1, 2024
  • OK: $98.17 (asc), effective Jan 1, 2026
  • TX: $74.34 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $78.13 (medical, facility), effective Jul 1, 2026
  • VT: $155.78 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $308.28 (asc), effective Jul 1, 2026
  • WY: $88.73 (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.