Payer policies › CPT 2593125931 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 25931 Payer coverage policies that name 25931 25931 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 25927-25931) 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: $374.14 (chp_plus, non-facility), effective Jul 1, 2026 FL: $608.38 (physician, non-facility), effective Jan 1, 2026 IL: $540.98 (practitioner), effective Apr 1, 2024 IN: $609.74 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $481.60 (default, Exempt Physician), effective Aug 1, 2024 KY: $1605.64 (asc), effective Jan 1, 2026 LA: $636.30 (professional), effective Jul 1, 2025 MA: $1093.32 (asc), effective May 1, 2026 MS: $1263.33 (comprehensive, facility), effective Oct 1, 2025 ND: $946.52 (physician, facility), effective Aug 1, 2026 NE: $147.96 (physician, non-facility), effective Jul 1, 2026 NY: $362.95 (physician_surgery, facility), effective Jul 1, 2026 OH: $436.09 (physician), effective Jan 1, 2024 OK: $674.23 (physician, non-facility), effective Jul 1, 2026 TX: $677.82 (physician, Physician, facility), effective Mar 1, 2026 VA: $677.66 (medical), effective Jul 1, 2026 VT: $2540.58 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $339.40 (asc), 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.