20664 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 20664

Payer coverage policies that name 20664

20664 appears in 3 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaIdiopathic Scoliosis (0398)covered if criteria are metSep 28, 2026payer document
AetnaRemote Ischemic Conditioning (0814)listed, no stance (range 20000-29999)Nov 20, 2025payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 20100-29999)Jul 29, 2026payer document

Medicaid fee-for-service

  • AZ: $632.02 (asc), effective Oct 1, 2026
  • CO: $709.52 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $732.55 (physician, non-facility), effective Jan 1, 2026
  • IL: $634.44 (practitioner), effective Apr 1, 2024
  • IN: $667.69 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $350.00 (asc, facility), effective Jan 1, 1998
  • KY: $346.60 (physician, facility), effective Jan 1, 2026
  • LA: $724.59 (professional), effective Jul 1, 2025
  • MA: $668.09 (physician_surgery), effective May 1, 2024
  • MS: $755.73 (comprehensive), effective Jul 1, 2026
  • ND: $636.40 (physician, facility), effective Aug 1, 2026
  • NE: $778.04 (physician, non-facility), effective Jul 1, 2026
  • NY: $356.29 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $455.07 (physician), effective Jan 1, 2024
  • OK: $805.39 (physician, non-facility), effective Jul 1, 2026
  • TX: $770.44 (physician, Physician, facility), effective Mar 1, 2026
  • VA: $815.97 (medical), effective Jul 1, 2026
  • VT: $1248.54 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $554.19 (physician, facility), effective Jul 1, 2026
  • WY: $711.11 (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.