Payer policies › CPT 2664126641 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 26641 Payer coverage policies that name 26641 26641 appears in 5 coverage policies from Aetna, Cigna.
Payer Policy Role in policy Reviewed Document Aetna Bupivacaine Liposome (Exparel) (0941) listed, no stance (range 26600-26665) Jul 30, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance (range 26010-26989) 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 Cigna Manipulation Under Anesthesia (0276) covered if criteria are met Sep 15, 2026 payer document
Medicaid fee-for-service AZ: $74.77 (asc), effective Oct 1, 2026 CO: $319.48 (chp_plus, non-facility), effective Jul 1, 2026 FL: $298.74 (physician, facility), effective Jan 1, 2026 IL: $266.75 (practitioner), effective Apr 1, 2024 IN: $304.23 (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: $342.66 (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: $149.48 (physician, facility), effective Jul 1, 2026 NY: $148.11 (physician_surgery, facility), effective Jul 1, 2026 OH: $199.16 (physician, facility), effective Jan 1, 2024 OK: $331.53 (physician, facility), effective Jul 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: $332.75 (medical, facility), effective Jul 1, 2026 VT: $191.53 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $231.04 (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.