25448 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 25448

Payer coverage policies that name 25448

25448 appears in 4 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaIntraoperative Neurophysiological Monitoring (0697)not covered (range 25000-25999)Jun 19, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 25000-25999)Jul 23, 2026payer document
AetnaNerve Blocks (0863)listed, no stanceJul 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

Prior authorization required or conditional in IN, LA, NE, WV.

  • AZ: $1062.88 (asc), effective Oct 1, 2026
  • CO: $698.44 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $637.22 (physician, non-facility), effective Jan 1, 2026
  • IL: $607.73 (practitioner), effective Jan 1, 2025
  • IN: $686.61 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $1026.45 (asc, facility), effective Jan 1, 2025
  • KY: $1605.64 (asc), effective Jan 1, 2026
  • LA: $619.73 (professional), effective Jan 1, 2025
  • MA: $1342.29 (asc), effective May 1, 2026
  • MS: $1263.33 (comprehensive, facility), effective Oct 1, 2025
  • ND: $946.52 (physician, facility), effective Aug 1, 2026
  • NE: $912.91 (physician, non-facility), effective Jul 1, 2026
  • NY: $479.90 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $668.92 (physician), effective Jan 1, 2025
  • OK: $2946.45 (outpatient_hospital_apc), effective Jan 1, 2026
  • VA: $709.78 (medical, facility), effective Jul 1, 2026
  • VT: $2540.58 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1447.00 (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.