12016 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 12016

Payer coverage policies that name 12016

12016 appears in 2 coverage policies from Aetna.

Medicaid fee-for-service

• AZ: $123.04 (asc), effective Oct 1, 2026
• CO: $104.74 (chp_plus, non-facility), effective Jul 1, 2026
• FL: $95.08 (physician, facility), effective Jan 1, 2026
• IL: $129.79 (practitioner), effective Apr 1, 2024
• IN: $95.72 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
• KS: $324.00 (asc, facility), effective Aug 1, 1982
• KY: $217.69 (asc), effective Jan 1, 2026
• LA: $182.30 (asc), effective Jul 1, 2012
• MA: $137.23 (asc), effective May 1, 2026
• MS: $171.51 (comprehensive, facility), effective Oct 1, 2025
• ND: $128.33 (physician, facility), effective Aug 1, 2026
• NE: $413.00 (asc), effective Jul 1, 2024
• NY: $98.50 (nurse_practitioner, facility), effective Jul 1, 2026
• OH: $98.41 (physician, facility), effective Dec 31, 2013
• OK: $198.60 (asc), effective Jan 1, 2026
• TX: $143.08 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
• VA: $105.90 (medical, facility), effective Jul 1, 2026
• VT: $315.64 (outpatient_hospital_opps), effective Feb 1, 2026
• WA: $308.28 (asc), 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.