Payer policies › CPT 2506525065 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 25065 Payer coverage policies that name 25065 25065 appears in 4 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Intraoperative Neurophysiological Monitoring (0697) not covered (range 25000-25999) Jun 19, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance (range 25000-25999) 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: $102.30 (asc), effective Oct 1, 2026 CO: $127.40 (chp_plus, non-facility), effective Jul 1, 2026 FL: $113.52 (physician, facility), effective Jan 1, 2026 IL: $113.60 (practitioner), effective Jul 1, 2026 IN: $122.31 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $300.00 (asc, facility), effective Aug 1, 1982 KY: $182.51 (asc), effective Jan 1, 2026 LA: $200.41 (professional), effective Jul 1, 2025 MA: $155.22 (asc), effective May 1, 2026 MS: $137.41 (comprehensive, facility), effective Oct 1, 2025 ND: $180.52 (physician, facility), effective Aug 1, 2026 NY: $77.55 (physician_surgery, facility), effective Jul 1, 2026 OH: $89.47 (physician, facility), effective Jan 1, 2024 OK: $127.68 (physician, facility), effective Jul 1, 2026 TX: $149.50 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $126.45 (medical, facility), effective Jul 1, 2026 VT: $1282.40 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $87.33 (physician, facility), effective Jul 1, 2026 WY: $730.40 (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.