16035 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 16035

Payer coverage policies that name 16035

16035 appears in 1 coverage policy from Aetna.

Medicaid fee-for-service

• AZ: $123.04 (asc), effective Oct 1, 2026
• CO: $157.92 (chp_plus, non-facility), effective Jul 1, 2026
• FL: $199.72 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
• IL: $135.86 (practitioner), effective Apr 1, 2024
• IN: $149.34 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
• KS: $350.00 (asc, facility), effective Aug 1, 1982
• KY: $217.69 (asc), effective Jan 1, 2026
• LA: $165.90 (professional), effective Feb 1, 2013
• 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: $385.32 (physician, non-facility), effective Jul 1, 2026
• NY: $101.87 (physician_surgery, facility), effective Jul 1, 2026
• OH: $180.72 (physician), effective Jan 1, 2010
• OK: $159.27 (physician, non-facility), effective Jul 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: $154.80 (medical), 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.