Payer policies › CPT 2592025920 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 25920 Payer coverage policies that name 25920 25920 appears in 6 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Complex Regional Pain Syndrome (CRPS): Treatments (0447) not covered (range 25920-25924) Jul 16, 2026 payer 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: $1062.88 (asc), effective Oct 1, 2026 CO: $299.30 (chp_plus, non-facility), effective Jul 1, 2026 FL: $542.40 (physician, non-facility), effective Jan 1, 2026 IL: $502.38 (practitioner), effective Apr 1, 2024 IN: $563.22 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $438.70 (default, Exempt Physician), effective Aug 1, 2024 KY: $454.30 (physician, facility), effective Jan 1, 2026 LA: $589.33 (professional), effective Jul 1, 2025 MA: $558.60 (physician_surgery), effective May 1, 2024 MS: $570.59 (comprehensive), effective Jul 1, 2026 ND: $946.52 (physician, facility), effective Aug 1, 2026 NE: $122.79 (physician, non-facility), effective Jul 1, 2026 NY: $328.19 (physician_surgery, facility), effective Jul 1, 2026 OH: $461.81 (physician), effective Jan 1, 2024 OK: $605.78 (physician, non-facility), effective Jul 1, 2026 TX: $597.16 (physician, Physician, facility), effective Mar 1, 2026 VA: $604.17 (medical), effective Jul 1, 2026 VT: $2540.58 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $415.45 (physician, facility), 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.