33964 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 33964

Payer coverage policies that name 33964

33964 appears in 16 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts.

PayerPolicyRole in policyReviewedDocument
AetnaAnesthetic and Antiemetic Infusion Pumps (0607)listed, no stance (range 33016-37799)Sep 9, 2026payer document
AetnaBupivacaine Liposome (Exparel) (0941)listed, no stance (range 33010-37799)Jul 30, 2026payer document
AetnaCardiovascular Ultrafiltration (0741)listed, no stance (range 33010-37790)Oct 30, 2025payer document
AetnaCryoanalgesia and Therapeutic Cold (0297)listed, no stance (range 33016-33999)Apr 14, 2026payer document
AetnaExtracorporeal Membrane Oxygenation (ECMO) (0546)covered if criteria are metAug 27, 2026payer document
AetnaFunctional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677)listed, no stance (range 33016-33999)Sep 10, 2026payer document
AetnaInpatient Admission Prior to Surgery (Preop Days) (0255)listed, no stance (range 33016-33980)May 13, 2026payer document
AetnaIntravenous Iron Therapy (0575)listed, no stance (range 33016-33999)Jul 1, 2026payer document
AetnaNegative Pressure Wound Therapy (0334)listed, no stance (range 33016-37799)Jun 8, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 33016-33999)Jul 23, 2026payer document
AetnaNitric Oxide, Inhalational (INO) (0518)not covered (range 33016-37790)Jul 2, 2026payer document
AetnaPalivizumab (Synagis) (0318)listed, no stance (range 33946-33986)Aug 21, 2026payer document
AetnaProcalcitonin (PCT) (0771)listed, no stance (range 33016-33997)Nov 13, 2025payer document
AetnaStereolithographic Models and Implants (0613)listed, no stance (range 33010-37790)Sep 3, 2026payer document
Blue Cross & Blue Shield of MississippiHeartlung Transplantcovered if criteria are metpayer document
Blue Cross Blue Shield of MassachusettsExtracorporeal Membrance Oxygenation (726)listed, no stancepayer document

Medicaid fee-for-service

  • AZ: $488.14 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $383.33 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $351.21 (physician, non-facility), effective Jan 1, 2026
  • IL: $342.78 (practitioner), effective Apr 1, 2024
  • IN: $358.95 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $208.94 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $418.72 (physician, facility), effective Jan 1, 2026
  • LA: $485.63 (professional), effective Jan 1, 2015
  • MA: $348.23 (physician_surgery), effective May 1, 2024
  • MS: $380.52 (comprehensive), effective Jul 1, 2026
  • ND: $458.48 (physician), effective Aug 1, 2026
  • NE: $881.78 (physician, non-facility), effective Jul 1, 2026
  • NY: $333.57 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $459.84 (physician), effective Jan 1, 2015
  • OK: $400.54 (physician, non-facility), effective Jul 1, 2026
  • TX: $379.47 (physician, Physician, facility), effective Sep 1, 2026
  • VA: $391.20 (medical, facility), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $257.22 (physician, facility), effective Jul 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.