Payer policies › CPT 2591525915 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 25915 Payer coverage policies that name 25915 25915 appears in 5 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 Aetna Upper Limb Prostheses (0399) listed, no stance (range 25900-25931) Jul 16, 2026 payer document
Medicaid fee-for-service AZ: $3026.13 (asc), effective Oct 1, 2026 CO: $411.54 (chp_plus, non-facility), effective Jul 1, 2026 FL: $807.65 (physician, non-facility), effective Jan 1, 2026 IL: $1156.79 (practitioner), effective Apr 1, 2024 IN: $893.84 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KY: $974.92 (physician, facility), effective Jan 1, 2026 LA: $956.18 (professional), effective Feb 1, 2013 MA: $871.90 (physician_surgery), effective May 1, 2024 MS: $879.05 (comprehensive), effective Jul 1, 2026 ND: $2126.56 (physician, facility), effective Aug 1, 2026 NE: $171.62 (physician, non-facility), effective Jul 1, 2026 NY: $611.47 (physician_surgery, facility), effective Jul 1, 2026 OH: $911.48 (physician), effective Jan 1, 2000 OK: $929.83 (physician, non-facility), effective Jul 1, 2026 TX: $146.55 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2026 VA: $917.82 (medical), effective Jul 1, 2026 VT: $5634.17 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $620.50 (physician, facility), 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.