23616 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 23616

Payer coverage policies that name 23616

23616 appears in 7 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 23570-23630)Jul 30, 2026payer document
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

Medicaid fee-for-service

  • AZ: $12277.84 (asc), effective Oct 1, 2026
  • CO: $986.27 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $872.31 (physician, non-facility), effective Jan 1, 2026
  • IL: $975.25 (practitioner), effective Jul 1, 2026
  • IN: $945.91 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $350.00 (asc, facility), effective Jan 1, 1993
  • KY: $13116.83 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $9920.13 (asc), effective May 1, 2026
  • MS: $11356.66 (comprehensive, facility), effective Oct 1, 2025
  • ND: $7732.38 (physician, facility), effective Aug 1, 2026
  • NE: $1662.00 (asc), effective Jul 1, 2024
  • NY: $637.19 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $1091.07 (physician), effective Jan 1, 2010
  • OK: $11966.75 (asc), effective Jan 1, 2026
  • TX: $9515.63 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $971.64 (medical), effective Jul 1, 2026
  • VT: $13614.33 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $647.27 (asc), effective Jul 1, 2026
  • WY: $7754.10 (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.