25530 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 25530

Payer coverage policies that name 25530

25530 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: $74.77 (asc), effective Oct 1, 2026
  • CO: $213.14 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $197.69 (physician, facility), effective Jan 1, 2026
  • IL: $199.75 (practitioner), effective Jul 1, 2026
  • IN: $196.74 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $300.00 (asc, facility), effective Aug 1, 1982
  • KY: $132.31 (asc), effective Jan 1, 2026
  • LA: $216.67 (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: $240.61 (physician, facility), effective Jul 1, 2026
  • NY: $103.78 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $130.84 (physician, facility), effective Jan 1, 2024
  • OK: $120.71 (asc), effective Jan 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: $220.20 (medical, facility), effective Jul 1, 2026
  • VT: $191.53 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $154.41 (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.