Payer policies › CPT 4297142971 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 42971 Payer coverage policies that name 42971 42971 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: $468.96 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $115.98 (chp_plus, non-facility), effective Jul 1, 2026 FL: $315.74 (physician, non-facility), effective Jan 1, 2026 IL: $310.75 (practitioner), effective Apr 1, 2024 IN: $351.05 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $550.00 (asc, facility), effective Aug 1, 1982 KY: $249.20 (physician, facility), effective Jan 1, 2026 LA: $367.25 (professional), effective Jul 1, 2025 MA: $343.64 (physician_surgery), effective May 1, 2024 MS: $333.31 (comprehensive), effective Jul 1, 2026 ND: $428.81 (physician), effective Aug 1, 2026 NE: $57.69 (physician, non-facility), effective Jul 1, 2026 NY: $221.62 (physician_surgery, facility), effective Jul 1, 2026 OH: $273.27 (physician), effective Jan 1, 2024 OK: $352.46 (physician, non-facility), effective Jul 1, 2026 TX: $319.96 (physician, Physician, facility), effective Sep 1, 2026 VA: $346.35 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $236.96 (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.