Payer policies › CPT 4350043500 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 43500 Medicaid fee-for-service AZ: $808.91 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $618.18 (chp_plus, non-facility), effective Jul 1, 2026 FL: $792.06 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $599.35 (practitioner), effective Jul 1, 2026 IN: $594.43 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $450.00 (asc, facility), effective Aug 1, 1982 KY: $416.59 (physician, facility), effective Jan 1, 2026 LA: $128.49 (professional), effective Jul 1, 2025 MA: $577.82 (physician_surgery), effective May 1, 2024 MS: $622.80 (comprehensive), effective Jul 1, 2026 ND: $772.76 (physician), effective Aug 1, 2026 NE: $1148.54 (physician, non-facility), effective Jul 1, 2026 NY: $351.92 (physician_surgery, facility), effective Jul 1, 2026 OH: $418.52 (physician), effective Jan 1, 2024 OK: $658.58 (physician, non-facility), effective Jul 1, 2026 TX: $93.00 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $651.33 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $435.52 (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.