4151F CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 4151F

Medicaid fee-for-service

Prior authorization required or conditional in IN.

• VT: $0.00 (outpatient_hospital_opps), effective Feb 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.