Payer policies › CPT 2725827258 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 27258 Payer coverage policies that name 27258 27258 appears in 4 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Intraoperative Neurophysiological Monitoring (0697) not covered (range 26990-27299) Jun 19, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance (range 26990-27299) 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
Medicaid fee-for-service AZ: $1062.88 (asc), effective Oct 1, 2026 CO: $888.30 (chp_plus, non-facility), effective Jul 1, 2026 FL: $792.56 (physician, non-facility), effective Jan 1, 2026 IL: $770.39 (practitioner), effective Apr 1, 2024 IN: $852.39 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $400.00 (asc, facility), effective Aug 1, 1982 KY: $845.48 (physician, facility), effective Jan 1, 2026 LA: $900.86 (professional), effective Jul 1, 2025 MA: $833.16 (physician_surgery), effective May 1, 2024 MS: $843.32 (comprehensive), effective Jul 1, 2026 ND: $946.52 (physician, facility), effective Aug 1, 2026 NE: $1333.80 (physician, non-facility), effective Jul 1, 2026 NY: $536.37 (physician_surgery, facility), effective Jul 1, 2026 OH: $837.15 (physician), effective Jan 1, 2024 OK: $892.71 (physician, non-facility), effective Jul 1, 2026 TX: $139.73 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2026 VA: $882.81 (medical), effective Jul 1, 2026 VT: $2540.58 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $598.72 (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.