43325 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 43325

Payer coverage policies that name 43325

43325 appears in 4 coverage policies from Aetna, Regence.

PayerPolicyRole in policyReviewedDocument
AetnaBarrett's Esophagus (0728)covered if criteria are metNov 25, 2025payer document
AetnaGastroesophageal Reflux Disease (GERD) (0213)covered if criteria are metJul 21, 2026payer document
AetnaLung Transplantation (0598)not coveredSep 8, 2026payer document
RegenceGastroesophageal Reflux Surgery (Surgery 186)
NOTES
listed, no stanceFeb 1, 2026payer document

Medicaid fee-for-service

  • AZ: $1389.10 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $1067.02 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $1350.37 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IL: $960.09 (practitioner), effective Apr 1, 2024
  • IN: $1018.73 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $785.32 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $796.34 (physician, facility), effective Jan 1, 2026
  • LA: $221.75 (professional), effective Jul 1, 2025
  • MA: $996.33 (physician_surgery), effective May 1, 2024
  • MS: $1056.87 (comprehensive), effective Jul 1, 2026
  • ND: $1299.58 (physician), effective Aug 1, 2026
  • NE: $1704.30 (physician, non-facility), effective Jul 1, 2026
  • NY: $613.07 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $801.63 (physician), effective Jan 1, 2024
  • OK: $1116.69 (physician, non-facility), effective Jul 1, 2026
  • TX: $157.45 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026
  • VA: $1102.72 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $733.63 (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.