`1504F` CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 1504F

Payer coverage policies that name 1504F

1504F appears in 2 coverage policies from Aetna.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Beremagene Geperpavec-svdt (Vyjuvek) (1033)	listed, no stance (range 15040-15261)	Jun 12, 2026	payer document
Aetna	Skin and Soft Tissue Substitutes (0244)	not covered (range 10040-19499)	Jul 29, 2026	payer document

Medicaid fee-for-service

Prior authorization required or conditional in IN.

VT: $0.00 (outpatient_hospital_opps), effective Feb 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.

1504F CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 1504F

Payer coverage policies that name 1504F

Medicaid fee-for-service

`1504F` CPT® code: payer coverage and prior authorization