42226 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 42226

Payer coverage policies that name 42226

42226 appears in 1 coverage policy from Aetna.

Medicaid fee-for-service

Prior authorization required or conditional in WA, WY.

• AZ: $1943.46 (asc), effective Oct 1, 2026
• CO: $738.92 (chp_plus, non-facility), effective Jul 1, 2026
• FL: $649.17 (physician, non-facility), effective Jan 1, 2026
• IL: $784.75 (practitioner), effective Jul 1, 2026
• IN: $698.26 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
• KS: $616.98 (default, Exempt Physician), effective Aug 1, 2024
• KY: $2953.46 (asc), effective Jan 1, 2026
• LA: $233.58 (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: $1233.00 (asc), effective Jul 1, 2024
• NY: $470.73 (physician_surgery, facility), effective Jul 1, 2026
• OH: $552.78 (physician), 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: $723.09 (medical), effective Jul 1, 2026
• VT: $4596.52 (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.