23550 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 23550

Payer coverage policies that name 23550

23550 appears in 8 coverage policies from Aetna, Premera Blue Cross, Regence.

PayerPolicyRole in policyReviewedDocument
AetnaContinuous Passive Motion (CPM) Machines (0010)listed, no stance (range 23000-23921)Mar 5, 2026payer document
AetnaInfusion Pumps (0161)listed, no stance (range 23000-23921)Mar 31, 2026payer document
AetnaIntraoperative Neurophysiological Monitoring (0697)not covered (range 23000-23929)Jun 19, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 23000-23929)Jul 23, 2026payer document
AetnaRemote Ischemic Conditioning (0814)listed, no stance (range 20000-29999)Nov 20, 2025payer document
AetnaSkin and Soft Tissue Substitutes (0244)not covered (range 20100-29999)Jul 29, 2026payer document
Premera Blue CrossShoulder Open Procedures (7.01.605)
Page | 11 of 26 | ∞
listed, no stanceMay 12, 2026payer document
RegenceSurgical Site of Care – Hospital Outpatient (Utilization Management 19)listed, no stanceMay 1, 2026payer document

Medicaid fee-for-service

  • AZ: $3687.26 (asc), effective Oct 1, 2026
  • CO: $464.34 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $420.57 (physician, non-facility), effective Jan 1, 2026
  • IL: $503.60 (practitioner), effective Jul 1, 2026
  • IN: $444.52 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $250.00 (asc, facility), effective Aug 1, 1982
  • KY: $4786.87 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $2382.86 (asc), effective May 1, 2026
  • MS: $3653.92 (comprehensive, facility), effective Oct 1, 2025
  • ND: $2821.87 (physician, facility), effective Aug 1, 2026
  • NE: $1183.00 (asc), effective Jul 1, 2024
  • NY: $275.62 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $439.35 (physician), effective Jan 1, 2024
  • OK: $4367.16 (asc), effective Jan 1, 2026
  • TX: $3155.24 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $468.46 (medical), effective Jul 1, 2026
  • VT: $5634.17 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $415.35 (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.