42900 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 42900

Payer coverage policies that name 42900

42900 appears in 1 coverage policy from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaObstructive Sleep Apnea in Children (0752)listed, no stance (range 42700-42999)Oct 30, 2025payer document

Medicaid fee-for-service

  • AZ: $643.10 (asc), effective Oct 1, 2026
  • CO: $265.78 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $230.48 (physician, non-facility), effective Jan 1, 2026
  • IN: $256.35 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $227.79 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $1084.06 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $456.11 (asc), effective May 1, 2026
  • MS: $886.64 (comprehensive, facility), effective Oct 1, 2025
  • ND: $639.06 (physician, facility), effective Aug 1, 2026
  • NE: $637.00 (asc), effective Jul 1, 2024
  • NY: $168.33 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $258.17 (physician), effective Jan 1, 2000
  • OK: $989.01 (asc), effective Jan 1, 2026
  • TX: $746.26 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $250.29 (medical), effective Jul 1, 2026
  • VT: $1204.74 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $308.28 (asc), effective Jul 1, 2026
  • WY: $686.17 (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.