23620 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 23620

Payer coverage policies that name 23620

23620 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: $74.77 (asc), effective Oct 1, 2026
  • CO: $221.24 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $211.19 (physician, facility), effective Jan 1, 2026
  • IL: $180.89 (practitioner), effective Apr 1, 2024
  • IN: $208.60 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $350.00 (asc, facility), effective Aug 1, 1982
  • KY: $132.31 (asc), effective Jan 1, 2026
  • LA: $222.15 (professional), effective Jul 1, 2025
  • MA: $92.62 (asc), effective May 1, 2026
  • MS: $103.14 (comprehensive, facility), effective Oct 1, 2025
  • ND: $77.99 (physician, facility), effective Aug 1, 2026
  • NE: $91.22 (physician, facility), effective Jul 1, 2026
  • NY: $113.48 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $161.07 (physician, facility), effective Jan 1, 2024
  • OK: $233.57 (physician, facility), effective Jul 1, 2026
  • TX: $85.32 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $235.24 (medical, facility), effective Jul 1, 2026
  • VT: $191.53 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $164.54 (physician, facility), effective Jul 1, 2026
  • WY: $109.09 (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.