28003 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 28003

Payer coverage policies that name 28003

28003 appears in 5 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi.

PayerPolicyRole in policyReviewedDocument
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 28001-28899)Jul 30, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 28001-28899)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
Blue Cross & Blue Shield of MississippiFoot Care Services (L.9.01.401)covered if criteria are met (range 28001-28899)payer document

Medicaid fee-for-service

  • AZ: $1062.88 (asc), effective Oct 1, 2026
  • CO: $210.07 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $209.29 (physician, facility), effective Jan 1, 2026
  • IL: $246.85 (podiatrist), effective Apr 1, 2024
  • IN: $200.29 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $357.29 (default, Exempt Physician), effective Jul 1, 2023
  • KY: $1605.64 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • 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: $552.00 (asc), effective Jul 1, 2024
  • NY: $276.16 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $249.42 (physician, facility), effective Dec 31, 2013
  • OK: $1464.86 (asc), effective Jan 1, 2026
  • TX: $1088.27 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $199.94 (medical, facility), 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.