Payer policies › CPT 2080520805 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 20805 Payer coverage policies that name 20805 20805 appears in 2 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Remote Ischemic Conditioning (0814) listed, no stance (range 20000-29999) Nov 20, 2025 payer document Aetna Skin and Soft Tissue Substitutes (0244) not covered (range 20100-29999) Jul 29, 2026 payer document
Medicaid fee-for-service AZ: $12549.16 (asc), effective Oct 1, 2026 CO: $2431.85 (chp_plus, non-facility), effective Jul 1, 2026 FL: $2257.70 (physician, non-facility), effective Jan 1, 2026 IL: $2257.88 (practitioner), effective Apr 1, 2024 IN: $2474.60 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $1149.07 (default, Exempt Physician), effective Aug 1, 2024 KY: $2842.59 (physician, facility), effective Jan 1, 2026 LA: $527.17 (professional), effective Jul 1, 2025 MA: $2411.41 (physician_surgery), effective May 1, 2024 MS: $2416.64 (comprehensive), effective Jul 1, 2026 ND: $8017.73 (physician, facility), effective Aug 1, 2026 NE: $4816.50 (physician, non-facility), effective Jul 1, 2026 NY: $1511.84 (physician_surgery, facility), effective Jul 1, 2026 OH: $2616.58 (physician), effective Jan 1, 2000 OK: $2553.07 (physician, non-facility), effective Jul 1, 2026 TX: $386.58 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2026 VA: $2511.58 (medical), effective Jul 1, 2026 VT: $13614.33 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $1687.80 (physician, facility), effective Jul 1, 2026 WY: $7754.10 (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.