15958 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 15958

Payer coverage policies that name 15958

15958 appears in 1 coverage policy from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 10040-19499)Jul 29, 2026payer document

Medicaid fee-for-service

  • AZ: $1177.45 (asc), effective Oct 1, 2026
  • CO: $958.68 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $842.96 (physician, non-facility), effective Jan 1, 2026
  • IL: $807.17 (practitioner), effective Apr 1, 2024
  • IN: $889.31 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $443.94 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $1894.49 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $1278.72 (asc), effective May 1, 2026
  • MS: $1565.86 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1116.80 (physician, facility), effective Aug 1, 2026
  • NE: $637.00 (asc), effective Jul 1, 2024
  • NY: $549.37 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $922.68 (physician), effective Jan 1, 2024
  • OK: $1728.38 (asc), effective Jan 1, 2026
  • TX: $1457.62 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $938.95 (medical), effective Jul 1, 2026
  • VT: $2751.56 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1567.17 (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.