Payer policies › CPT 4342043420 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 43420 Medicaid fee-for-service AZ: $926.87 (asc), effective Oct 1, 2026 CO: $814.58 (chp_plus, non-facility), effective Jul 1, 2026 FL: $1037.02 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $700.15 (practitioner), effective Apr 1, 2024 IN: $785.41 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $362.35 (default, Exempt Physician), effective Aug 1, 2024 KY: $1445.19 (asc), effective Jan 1, 2026 LA: $165.35 (professional), effective Jul 1, 2025 MA: $762.30 (physician_surgery), effective May 1, 2024 MS: $740.56 (comprehensive), effective Jul 1, 2026 ND: $934.60 (physician), effective Aug 1, 2026 NE: $1000.34 (physician, non-facility), effective Jul 1, 2026 NY: $467.07 (physician_surgery, facility), effective Jul 1, 2026 OH: $552.99 (physician), effective Jan 1, 2024 OK: $780.84 (physician, non-facility), effective Jul 1, 2026 TX: $738.45 (physician, Physician, facility), effective Sep 1, 2026 VA: $761.29 (medical), effective Jul 1, 2026 VT: $2574.33 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $515.21 (physician, facility), effective Jul 1, 2026 WY: $1466.22 (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.