Payer policies › CPT 4310143101 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 43101 Payer coverage policies that name 43101 43101 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Barrett's Esophagus (0728) covered if criteria are met Nov 25, 2025 payer document
Medicaid fee-for-service AZ: $1018.47 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $710.84 (chp_plus, non-facility), effective Jul 1, 2026 FL: $753.34 (physician, non-facility), effective Jan 1, 2026 IL: $749.20 (practitioner), effective Jul 1, 2026 IN: $748.02 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $657.83 (default, Exempt Physician), effective Aug 1, 2024 KY: $743.34 (physician, facility), effective Jan 1, 2026 LA: $815.30 (professional), effective Jul 1, 2025 MA: $730.12 (physician_surgery), effective May 1, 2024 MS: $805.01 (comprehensive), effective Jul 1, 2026 ND: $995.43 (physician), effective Aug 1, 2026 NE: $325.51 (physician, non-facility), effective Jul 1, 2026 NY: $491.62 (physician_surgery, facility), effective Jul 1, 2026 OH: $746.69 (physician), effective Jan 1, 2024 OK: $850.37 (physician, non-facility), effective Jul 1, 2026 TX: $114.11 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $839.12 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $560.31 (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.