25520 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 25520

Payer coverage policies that name 25520

25520 appears in 5 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 25500-25652)Jul 30, 2026payer document
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
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: $504.49 (asc), effective Oct 1, 2026
  • CO: $452.52 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $413.81 (physician, facility), effective Jan 1, 2026
  • IL: $379.54 (practitioner), effective Apr 1, 2024
  • IN: $429.29 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $300.00 (asc, facility), effective Jan 1, 1993
  • KY: $852.05 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $606.05 (asc), effective May 1, 2026
  • MS: $670.63 (comprehensive, facility), effective Oct 1, 2025
  • ND: $502.29 (physician, facility), effective Aug 1, 2026
  • NE: $413.00 (asc), effective Jul 1, 2024
  • NY: $245.45 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $353.92 (physician, facility), effective Jan 1, 2024
  • OK: $777.34 (asc), effective Jan 1, 2026
  • TX: $593.04 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $460.94 (medical, facility), effective Jul 1, 2026
  • VT: $1248.54 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $308.28 (asc), effective Jul 1, 2026
  • WY: $711.11 (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.