25927 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 25927

Payer coverage policies that name 25927

25927 appears in 6 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaComplex Regional Pain Syndrome (CRPS): Treatments (0447)not covered (range 25927-25931)Jul 16, 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
AetnaUpper Limb Prostheses (0399)listed, no stance (range 25900-25931)Jul 16, 2026payer document

Medicaid fee-for-service

  • AZ: $1062.88 (asc), effective Oct 1, 2026
  • CO: $374.14 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $653.32 (physician, non-facility), effective Jan 1, 2026
  • IL: $585.70 (practitioner), effective Apr 1, 2024
  • IN: $659.56 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $300.00 (asc, facility), effective Aug 1, 1982
  • KY: $441.03 (physician, facility), effective Jan 1, 2026
  • LA: $688.55 (professional), effective Jul 1, 2025
  • MA: $668.61 (physician_surgery), effective May 1, 2024
  • MS: $680.99 (comprehensive), effective Jul 1, 2026
  • ND: $946.52 (physician, facility), effective Aug 1, 2026
  • NE: $147.96 (physician, non-facility), effective Jul 1, 2026
  • NY: $388.95 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $469.40 (physician), effective Jan 1, 2024
  • OK: $725.12 (physician, non-facility), effective Jul 1, 2026
  • TX: $698.74 (physician, Physician, facility), effective Mar 1, 2026
  • VA: $727.72 (medical), effective Jul 1, 2026
  • VT: $2540.58 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $505.27 (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.