20924 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 20924

2 of 2 payer prior-auth lists that name 20924 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Texas.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)Federal Employee Program (FEP)AZprior auth under conditionsFEP Blue Focus onlySep 1, 2026Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)
Blue Cross and Blue Shield of TexasTexas PA exemption (gold card), outpatient, fully insuredTXprior auth requiredGold-card exemption availableJul 1, 2026BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)

Payer coverage policies that name 20924

20924 appears in 2 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaRemote Ischemic Conditioning (0814)listed, no stance (range 20000-29999)Nov 20, 2025payer document
AetnaSkin and Soft Tissue Substitutes (0244)not coveredJul 29, 2026payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 20100-29999)Jul 29, 2026payer document

Medicaid fee-for-service

  • AZ: $3026.13 (asc), effective Oct 1, 2026
  • CO: $407.35 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $365.50 (physician, non-facility), effective Jan 1, 2026
  • IL: $347.05 (practitioner), effective Apr 1, 2024
  • IN: $391.96 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $410.00 (asc, facility), effective Aug 1, 1982
  • KY: $3607.39 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $2382.86 (asc), effective May 1, 2026
  • MS: $2808.67 (comprehensive, facility), effective Oct 1, 2025
  • ND: $2126.56 (physician, facility), effective Aug 1, 2026
  • NE: $785.00 (asc), effective Jul 1, 2024
  • NY: $245.27 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $346.37 (physician), effective Jan 1, 2024
  • OK: $3291.10 (asc), effective Jan 1, 2026
  • TX: $3159.44 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $407.12 (medical), effective Jul 1, 2026
  • VT: $5634.17 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $366.60 (asc), effective Jul 1, 2026
  • WY: $3208.96 (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.