Payer policies › CPT 1912619126 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 19126 Payer coverage policies that name 19126 19126 appears in 6 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Acupuncture and Dry Needling (0135) listed, no stance Mar 25, 2026 payer document Aetna Breast Biopsy Procedures (0269) listed, no stance (range 19120-19126) May 14, 2026 payer document Aetna Breast Implant Removal (0142) listed, no stance (range 19120-19126) Mar 19, 2026 payer document Aetna Breast Reconstructive Surgery (0185) listed, no stance (range 19120-19126) Apr 22, 2026 payer document Aetna Magnetic Resonance Imaging (MRI) of the Breast (0105) listed, no stance (range 19120-19126) Aug 6, 2026 payer document Aetna Skin and Soft Tissue Substitutes (0244) not covered (range 10040-19499) Jul 29, 2026 payer document
Medicaid fee-for-service AZ: $1796.27 (outpatient_hospital), effective Oct 1, 2013 CO: $127.68 (chp_plus, non-facility), effective Jul 1, 2026 FL: $111.96 (physician, non-facility), effective Jan 1, 2026 IL: $113.58 (practitioner), effective Jul 1, 2026 IN: $118.80 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $450.00 (asc, facility), effective Jan 1, 1994 KY: $0.00 (asc), effective Jan 1, 2026 LA: $217.00 (asc), effective Jul 1, 2012 MA: $0.00 (asc), effective May 1, 2026 MS: $120.83 (comprehensive), effective Jul 1, 2026 ND: $145.69 (physician), effective Aug 1, 2026 NE: $413.00 (asc), effective Jul 1, 2024 NY: $75.53 (physician_surgery, facility), effective Jul 1, 2026 OH: $124.72 (physician), effective Jan 1, 2024 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $127.50 (healthy_texas_women, Clinic/Group Practice, facility), effective Mar 1, 2023 VA: $124.71 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $81.98 (physician, facility), effective Jul 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.