43264 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 43264

Payer coverage policies that name 43264

43264 appears in 4 coverage policies from Aetna, Centene.

PayerPolicyRole in policyReviewedDocument
AetnaDouble Balloon Enteroscopy (0737)listed, no stance (range 43260-43273)Nov 13, 2025payer document
AetnaNerve Blocks (0863)listed, no stance (range 43260-43278)Jul 23, 2026payer document
AetnaUpper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (0738)covered if criteria are met (range 43233-43270)Oct 29, 2025payer document
CenteneAmbulatory Surgery Center Optimization Reference Number: CP.MP.158 (CP.MP.158)
References reviewed and updated | 01/19 | 01/19		covered if criteria are metJun 1, 2022payer document

Medicaid fee-for-service

  • AZ: $1501.24 (asc), effective Oct 1, 2026
  • CO: $283.98 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $246.80 (physician, non-facility), effective Jan 1, 2026
  • IL: $350.91 (practitioner), effective Apr 1, 2024
  • IN: $276.98 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $225.00 (asc, facility), effective Aug 1, 1982
  • KY: $1939.17 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $1110.22 (asc), effective May 1, 2026
  • MS: $1500.65 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1143.14 (physician, facility), effective Aug 1, 2026
  • NE: $552.00 (asc), effective Jul 1, 2024
  • NY: $282.80 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $352.96 (physician), effective Dec 31, 2014
  • OK: $1769.15 (asc), effective Jan 1, 2026
  • TX: $1119.26 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $274.88 (medical), effective Jul 1, 2026
  • VT: $2993.62 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1705.03 (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.