Payer policies › CPT 2138521385 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 21385 Payer coverage policies that name 21385 21385 appears in 3 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna General Anesthesia and Monitored Anesthesia Care for Oral and Maxillofacial Surgery and Dental Services (0124) covered if criteria are met (range 21295-21497) Mar 19, 2026 payer 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: $1943.46 (asc), effective Oct 1, 2026 CO: $600.50 (chp_plus, non-facility), effective Jul 1, 2026 FL: $524.48 (physician, non-facility), effective Jan 1, 2026 IL: $599.35 (practitioner), effective Jul 1, 2026 IN: $562.78 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $300.00 (asc, facility), effective Aug 1, 1982 KY: $2953.46 (asc), effective Jan 1, 2026 LA: $117.43 (professional), effective Jul 1, 2025 MA: $555.56 (physician_surgery), effective May 1, 2024 MS: $555.20 (comprehensive), effective Jul 1, 2026 ND: $719.44 (physician), effective Aug 1, 2026 NE: $201.21 (physician, non-facility), effective Jul 1, 2026 NY: $363.60 (physician_surgery, facility), effective Jul 1, 2026 OH: $528.14 (physician), effective Jan 1, 2024 OK: $5330.84 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $87.43 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), facility), effective Mar 1, 2026 VA: $584.20 (medical), effective Jul 1, 2026 VT: $4596.52 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $400.93 (physician, facility), effective Jul 1, 2026 WY: $2617.97 (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.