40842 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 40842

Medicaid fee-for-service

Prior authorization required or conditional in WY.

  • AZ: $1943.46 (asc), effective Oct 1, 2026
  • CO: $544.80 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $427.41 (physician, facility), effective Jan 1, 2026
  • IL: $463.48 (practitioner), effective Apr 1, 2024
  • IN: $475.52 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $400.00 (asc, facility), effective Aug 1, 1982
  • KY: $2953.46 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $1909.57 (asc), effective May 1, 2026
  • MS: $2333.88 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1741.07 (physician, facility), effective Aug 1, 2026
  • NE: $637.00 (asc), effective Jul 1, 2024
  • OH: $419.75 (physician, facility), effective Jan 1, 2024
  • OK: $2694.50 (asc), effective Jan 1, 2026
  • TX: $1954.22 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $471.64 (medical, facility), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $366.60 (asc), effective Jul 1, 2026
  • WY: $2617.97 (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.