Payer policies › CPT 2904029040 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 29040 Payer coverage policies that name 29040 29040 appears in 3 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Orthopedic Casts, Braces and Splints (0009) covered if criteria are met (range 29000-29584) Jan 20, 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: $84.24 (asc), effective Oct 1, 2026 CO: $127.21 (chp_plus, non-facility), effective Jul 1, 2026 FL: $128.33 (physician, facility), effective Jan 1, 2026 IL: $169.49 (practitioner), effective Apr 1, 2024 IN: $134.11 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $132.74 (default, Exempt Physician), effective Aug 1, 2024 KY: $149.96 (asc), effective Jan 1, 2026 LA: $236.35 (professional), effective Jul 1, 2025 MA: $98.70 (asc), effective May 1, 2026 MS: $114.02 (comprehensive, facility), effective Oct 1, 2025 ND: $88.40 (physician, facility), effective Aug 1, 2026 NE: $28.45 (physician, facility), effective Jul 1, 2026 NY: $74.26 (physician_surgery, facility), effective Jul 1, 2026 OH: $81.01 (physician, facility), effective Dec 31, 2013 OK: $143.56 (physician, facility), effective Jul 1, 2026 TX: $99.86 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $142.94 (medical, facility), effective Jul 1, 2026 VT: $217.17 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $308.28 (asc), effective Jul 1, 2026 WY: $123.69 (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.