Payer policies › CPT 3956139561 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 39561 Medicaid fee-for-service AZ: $1283.11 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $899.03 (chp_plus, non-facility), effective Jul 1, 2026 FL: $1264.29 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $877.30 (practitioner), effective Apr 1, 2024 IN: $944.19 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $435.00 (asc, facility), effective Jan 1, 2000 KY: $827.49 (physician, facility), effective Jan 1, 2026 LA: $203.36 (professional), effective Jul 1, 2025 MA: $917.79 (physician_surgery), effective May 1, 2024 MS: $1006.92 (comprehensive), effective Jul 1, 2026 ND: $1258.27 (physician), effective Aug 1, 2026 NE: $1926.60 (physician, non-facility), effective Jul 1, 2026 NY: $578.76 (physician_surgery, facility), effective Jul 1, 2026 OH: $849.71 (physician), effective Jan 1, 2024 OK: $1065.45 (physician, non-facility), effective Jul 1, 2026 TX: $143.46 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $1054.98 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $708.60 (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.