Payer policies › CPT 3940139401 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 39401 2 of 9 payer prior-auth lists that name 39401 require prior authorization or set conditions: Molina Healthcare of Ohio.
Payer coverage policies that name 39401 39401 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Nerve Blocks (0863) listed, no stance Jul 23, 2026 payer document
Recent prior-auth changes Jan 1, 2026: PA removed, Molina Healthcare of Illinois Jan 1, 2026: PA removed, Molina Healthcare of Michigan Jul 1, 2024: conditions changed, Molina Healthcare of Illinois Jan 1, 2024: PA added, Molina Healthcare of Michigan Medicaid fee-for-service AZ: $1984.28 (asc), effective Oct 1, 2026 CO: $245.95 (chp_plus, non-facility), effective Jul 1, 2026 FL: $227.56 (physician, non-facility), effective Jan 1, 2026 IL: $215.28 (practitioner), effective Apr 1, 2024 IN: $228.76 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $160.48 (default, Exempt Physician), effective Aug 1, 2024 KY: $253.10 (physician, facility), effective Jan 1, 2026 LA: $291.70 (professional), effective Jan 1, 2016 MA: $221.46 (physician_surgery), effective May 1, 2024 MS: $4591.06 (comprehensive), effective Jul 1, 2026 ND: $299.64 (physician), effective Aug 1, 2026 NE: $379.39 (physician, non-facility), effective Jul 1, 2026 NY: $180.25 (physician_surgery, facility), effective Jul 1, 2026 OH: $255.04 (physician), effective Jan 1, 2016 OK: $257.59 (physician, non-facility), effective Jul 1, 2026 TX: $245.87 (physician, Physician, facility), effective Sep 1, 2026 VA: $253.47 (medical, facility), effective Jul 1, 2026 VT: $4694.12 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $168.55 (physician, facility), effective Jul 1, 2026 WY: $2673.55 (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.