Payer policies › CPT 4320543205 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 43205 1 of 1 payer prior-auth lists that name 43205 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.
Payer coverage policies that name 43205 43205 appears in 2 coverage policies from Aetna, Centene.
Payer Policy Role in policy Reviewed Document Aetna Upper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (0738) covered if criteria are met (range 43200-43232) Oct 29, 2025 payer document Centene Anesthesiology Services for Gastrointestinal Endoscopy (CP.MP.161) covered if criteria are met May 1, 2019 payer document
Recent prior-auth changes Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2026: PA removed, UnitedHealthcare Oct 1, 2025: PA removed, Oxford Health Plans Jun 1, 2025: PA removed, Neighborhood Health Partnership May 30, 2025: PA removed, Cigna May 30, 2025: PA removed, Cigna Dec 1, 2024: conditions changed, UnitedHealthcare Dec 1, 2024: conditions changed, UnitedHealthcare Dec 1, 2024: conditions changed, Neighborhood Health Partnership Dec 1, 2024: conditions changed, Oxford Health Plans Medicaid fee-for-service AZ: $617.94 (asc), effective Oct 1, 2026 CO: $110.54 (chp_plus, non-facility), effective Jul 1, 2026 FL: $97.93 (physician, non-facility), effective Jan 1, 2026 IL: $136.01 (practitioner), effective Apr 1, 2024 IN: $107.58 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $225.00 (asc, facility), effective Jan 1, 1994 KY: $873.00 (asc), effective Jan 1, 2026 LA: $182.30 (asc), effective Jul 1, 2012 MA: $563.60 (asc), effective May 1, 2026 MS: $691.32 (comprehensive, facility), effective Oct 1, 2025 ND: $514.64 (physician, facility), effective Aug 1, 2026 NE: $413.00 (asc), effective Jul 1, 2024 NY: $107.32 (physician_surgery, facility), effective Jul 1, 2026 OH: $137.57 (physician), effective Dec 31, 2014 OK: $796.46 (asc), effective Jan 1, 2026 TX: $564.97 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023 VA: $109.09 (medical), effective Jul 1, 2026 VT: $1489.96 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $308.28 (asc), effective Jul 1, 2026 WY: $848.61 (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.