Payer policies › CPT 2880028800 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 28800 Payer coverage policies that name 28800 28800 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 Complex Regional Pain Syndrome (CRPS): Treatments (0447) not covered (range 28800-28805) Jul 16, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance (range 28001-28899) Jul 23, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance (range 28800-28825) 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: $1062.88 (asc), effective Oct 1, 2026 CO: $420.83 (chp_plus, non-facility), effective Jul 1, 2026 FL: $382.12 (physician, non-facility), effective Jan 1, 2026 IL: $485.50 (podiatrist), effective Oct 1, 2014 IN: $412.42 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $300.00 (asc, facility), effective Aug 1, 1982 KY: $423.54 (physician, facility), effective Jan 1, 2026 LA: $442.63 (professional), effective Feb 1, 2013 MA: $393.64 (physician_surgery), effective May 1, 2024 MS: $412.79 (comprehensive), effective Jul 1, 2026 ND: $946.52 (physician, facility), effective Aug 1, 2026 NE: $778.04 (physician, non-facility), effective Jul 1, 2026 NY: $282.22 (physician_surgery, facility), effective Jul 1, 2026 OH: $413.48 (physician), effective Jan 1, 2000 OK: $435.79 (physician, non-facility), effective Jul 1, 2026 TX: $58.32 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2026 VA: $425.64 (medical), effective Jul 1, 2026 VT: $2540.58 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $290.85 (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.