Payer policies › CPT 3940239402 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 39402 2 of 9 payer prior-auth lists that name 39402 require prior authorization or set conditions: Molina Healthcare of Ohio.
Payer coverage policies that name 39402 39402 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 Michigan Jan 1, 2026: PA removed, Molina Healthcare of Illinois 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: $320.05 (chp_plus, non-facility), effective Jul 1, 2026 FL: $293.80 (physician, non-facility), effective Jan 1, 2026 IL: $282.09 (practitioner), effective Apr 1, 2024 IN: $297.72 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $209.47 (default, Exempt Physician), effective Aug 1, 2024 KY: $330.66 (physician, facility), effective Jan 1, 2026 LA: $381.87 (professional), effective Jan 1, 2016 MA: $288.50 (physician_surgery), effective May 1, 2024 MS: $4591.06 (comprehensive), effective Jul 1, 2026 ND: $385.25 (physician), effective Aug 1, 2026 NE: $503.88 (physician, non-facility), effective Jul 1, 2026 NY: $235.17 (physician_surgery, facility), effective Jul 1, 2026 OH: $333.10 (physician), effective Jan 1, 2016 OK: $333.13 (physician, non-facility), effective Jul 1, 2026 TX: $317.44 (physician, Physician, facility), effective Sep 1, 2026 VA: $327.26 (medical, facility), effective Jul 1, 2026 VT: $4694.12 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $216.90 (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.