Payer policies › CPT 4295342953 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 42953 Payer coverage policies that name 42953 42953 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Obstructive Sleep Apnea in Children (0752) listed, no stance (range 42700-42999) Oct 30, 2025 payer document
Medicaid fee-for-service AZ: $980.81 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $782.17 (chp_plus, non-facility), effective Jul 1, 2026 FL: $695.41 (physician, non-facility), effective Jan 1, 2026 IN: $732.43 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $639.25 (default, Exempt Physician), effective Aug 1, 2024 KY: $433.56 (physician, facility), effective Jan 1, 2026 LA: $751.88 (professional), effective Jul 1, 2025 MA: $739.61 (physician_surgery), effective May 1, 2024 MS: $726.37 (comprehensive), effective Jul 1, 2026 ND: $973.28 (physician), effective Aug 1, 2026 NE: $204.17 (physician, non-facility), effective Jul 1, 2026 NY: $499.28 (physician_surgery, facility), effective Jul 1, 2026 OH: $582.63 (physician), effective Jan 1, 2024 OK: $773.24 (physician, non-facility), effective Jul 1, 2026 TX: $105.33 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $774.60 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $541.77 (physician, facility), effective Jul 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.