Payer policies › CPT 3690536905 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 36905 Payer coverage policies that name 36905 36905 appears in 7 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Anesthetic and Antiemetic Infusion Pumps (0607) listed, no stance (range 33016-37799) Sep 9, 2026 payer document Aetna Bupivacaine Liposome (Exparel) (0941) listed, no stance (range 33010-37799) Jul 30, 2026 payer document Aetna Cardiovascular Ultrafiltration (0741) listed, no stance (range 33010-37790) Oct 30, 2025 payer document Aetna Negative Pressure Wound Therapy (0334) listed, no stance (range 33016-37799) Jun 8, 2026 payer document Aetna Nitric Oxide, Inhalational (INO) (0518) not covered (range 33016-37790) Jul 2, 2026 payer document Aetna Stereolithographic Models and Implants (0613) listed, no stance (range 33010-37790) Sep 3, 2026 payer document Aetna Thrombectomy Systems (0568) covered if criteria are met (range 36904-36906) Sep 18, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in NE.
AZ: $5890.56 (asc), effective Oct 1, 2026 CO: $1075.10 (chp_plus, non-facility), effective Jul 1, 2026 FL: $300.04 (physician, facility), effective Jan 1, 2026 IL: $300.52 (practitioner), effective Apr 1, 2024 IN: $332.44 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $3674.49 (asc, facility), effective Jan 1, 2017 KY: $6730.07 (asc), effective Jan 1, 2026 LA: $233.58 (asc), effective Jan 1, 2017 MA: $3555.50 (asc), effective May 1, 2026 MS: $5192.88 (comprehensive, facility), effective Oct 1, 2025 ND: $3967.38 (physician, facility), effective Aug 1, 2026 NE: $569.08 (physician, non-facility), effective Jul 1, 2026 NY: $240.17 (physician_surgery, facility), effective Jul 1, 2026 OH: $350.00 (physician, facility), effective Jan 1, 2024 OK: $6139.98 (asc), effective Jan 1, 2026 TX: $4535.02 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $334.20 (medical, facility), effective Jul 1, 2026 VT: $8963.61 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $500.36 (asc), effective Jul 1, 2026 WY: $5105.26 (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.