Payer policies › CPT 4349643496 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 43496 1 of 1 payer prior-auth lists that name 43496 require prior authorization or set conditions: UnitedHealthcare Community Plan.
Medicaid fee-for-service AZ: $949.24 (physician, AHCCCS PT 08, facility), effective Oct 1, 2020 CO: $655.85 (chp_plus, non-facility), effective Jul 1, 2026 IL: $1778.60 (practitioner), effective Jul 1, 2026 IN: $862.65 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2024 KS: $1827.46 (default, Exempt Physician), effective Dec 18, 2009 KY: $0.00 (physician, facility), effective Jan 1, 2026 LA: $2635.69 (professional), effective Feb 1, 2013 MS: $1747.63 (comprehensive), effective Jul 1, 2026 ND: $0.00 (physician), effective Aug 1, 2026 NE: $739.80 (physician, non-facility), effective Jul 1, 2026 NY: $606.00 (physician_surgery, facility), effective Jul 1, 2026 OH: $1320.61 (physician), effective Sep 1, 2013 OK: $1762.77 (physician, non-facility), effective Jul 1, 2026 TX: $233.78 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $706.89 (medical), effective Jul 1, 2009 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $921.50 (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.