24495 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 24495

Payer coverage policies that name 24495

24495 appears in 3 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaIntraoperative Neurophysiological Monitoring (0697)not covered (range 23930-24999)Jun 19, 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: $3026.13 (asc), effective Oct 1, 2026
  • CO: $448.96 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $639.20 (physician, non-facility), effective Jan 1, 2026
  • IL: $618.46 (practitioner), effective Apr 1, 2024
  • IN: $699.57 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $441.54 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $3607.39 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $2382.86 (asc), effective May 1, 2026
  • MS: $2808.67 (comprehensive, facility), effective Oct 1, 2025
  • ND: $2126.56 (physician, facility), effective Aug 1, 2026
  • NE: $785.00 (asc), effective Jul 1, 2024
  • NY: $321.90 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $419.26 (physician), effective Jan 1, 2024
  • OK: $3291.10 (asc), effective Jan 1, 2026
  • TX: $2398.52 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $785.30 (medical), effective Jul 1, 2026
  • VT: $5634.17 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $366.60 (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.