Payer policies › CPT 2232822328 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 22328 Payer coverage policies that name 22328 22328 appears in 4 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Intraoperative Neurophysiological Monitoring (0697) covered if criteria are met (range 22310-22328) Jun 19, 2026 payer document Aetna Intraoperative Neurophysiological Monitoring (0697) not covered (range 22010-22899) Jun 19, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance (range 22010-22899) Jul 23, 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: $285.91 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $219.27 (chp_plus, non-facility), effective Jul 1, 2026 FL: $196.39 (physician, non-facility), effective Jan 1, 2026 IL: $1212.36 (practitioner), effective Apr 1, 2024 IN: $206.10 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $183.94 (default, Exempt Physician), effective Aug 1, 2024 KY: $270.79 (physician, facility), effective Jan 1, 2026 LA: $229.83 (professional), effective Jul 1, 2025 MA: $204.68 (physician_surgery), effective May 1, 2024 MS: $208.49 (comprehensive), effective Jul 1, 2026 ND: $248.95 (physician), effective Aug 1, 2026 NE: $518.70 (physician, non-facility), effective Jul 1, 2026 NY: $138.40 (physician_surgery, facility), effective Jul 1, 2026 OH: $237.83 (physician), effective Jan 1, 2000 OK: $220.49 (physician, non-facility), effective Jul 1, 2026 TX: $33.41 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2026 VA: $218.75 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $142.94 (physician, facility), effective Jul 1, 2026 WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.