Payer policies › CPT 2840628406 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 28406 Payer coverage policies that name 28406 28406 appears in 6 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi.
Payer Policy Role in policy Reviewed Document Aetna Bupivacaine Liposome (Exparel) (0941) listed, no stance (range 28001-28899) Jul 30, 2026 payer document Aetna Negative Pressure Wound Therapy (0334) listed, no stance (range 28400-28531) Jun 8, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance (range 28001-28899) 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 Blue Cross & Blue Shield of Mississippi Foot Care Services (L.9.01.401) covered if criteria are met (range 28001-28899) payer document
Medicaid fee-for-service AZ: $3026.13 (asc), effective Oct 1, 2026 CO: $460.01 (chp_plus, non-facility), effective Jul 1, 2026 FL: $427.32 (physician, non-facility), effective Jan 1, 2026 IL: $231.65 (podiatrist), effective Apr 1, 2024 IN: $458.46 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $300.00 (asc, facility), effective Aug 1, 1982 KY: $3607.39 (asc), effective Jan 1, 2026 LA: $182.30 (asc), effective Jul 1, 2012 MA: $2382.86 (asc), effective May 1, 2026 MS: $2808.67 (comprehensive, facility), effective Oct 1, 2025 ND: $2126.56 (physician, facility), effective Aug 1, 2026 NE: $637.00 (asc), effective Jul 1, 2024 NY: $259.59 (physician_surgery, facility), effective Jul 1, 2026 OH: $368.61 (physician), effective Jan 1, 2024 OK: $3291.10 (asc), effective Jan 1, 2026 TX: $2398.52 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $475.98 (medical), effective Jul 1, 2026 VT: $5634.17 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $366.60 (asc), effective Jul 1, 2026 WY: $3208.96 (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.