41114 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 41114

1 of 1 payer prior-auth lists that name 41114 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue).

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)Federal Employee Program (FEP)AZprior auth under conditionsFEP Blue Focus onlySep 1, 2026Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)

Medicaid fee-for-service

  • AZ: $926.87 (asc), effective Oct 1, 2026
  • CO: $501.76 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $430.86 (physician, non-facility), effective Jan 1, 2026
  • IL: $423.08 (practitioner), effective Apr 1, 2024
  • IN: $478.85 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $255.84 (asc, facility), effective Aug 1, 1982
  • KY: $1445.19 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $896.80 (asc), effective May 1, 2026
  • MS: $1115.56 (comprehensive, facility), effective Oct 1, 2025
  • ND: $851.94 (physician, facility), effective Aug 1, 2026
  • NE: $552.00 (asc), effective Jul 1, 2024
  • OH: $419.83 (physician), effective Jan 1, 2024
  • OK: $1318.48 (asc), effective Jan 1, 2026
  • TX: $886.62 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $475.12 (medical), effective Jul 1, 2026
  • VT: $2574.33 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1466.22 (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.