Payer policies › CPT 2151021510 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 21510 Payer coverage policies that name 21510 21510 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: $1062.88 (asc), effective Oct 1, 2026 CO: $360.64 (chp_plus, non-facility), effective Jul 1, 2026 FL: $360.04 (physician, non-facility), effective Jan 1, 2026 IL: $314.92 (practitioner), effective Apr 1, 2024 IN: $343.34 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $312.27 (asc, facility), effective Aug 1, 1982 KY: $262.21 (physician, facility), effective Jan 1, 2026 LA: $366.26 (professional), effective Jul 1, 2025 MA: $338.74 (physician_surgery), effective May 1, 2024 MS: $378.47 (comprehensive), effective Jul 1, 2026 ND: $946.52 (physician, facility), effective Aug 1, 2026 NE: $363.08 (physician, non-facility), effective Jul 1, 2026 NY: $227.83 (physician_surgery, facility), effective Jul 1, 2026 OH: $289.41 (physician), effective Jan 1, 2024 OK: $401.84 (physician, non-facility), effective Jul 1, 2026 TX: $385.64 (physician, Physician, facility), effective Mar 1, 2026 VA: $401.04 (medical), effective Jul 1, 2026 VT: $2540.58 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $273.85 (physician, facility), effective Jul 1, 2026 WY: $1447.00 (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.