Payer policies › CPT 4360543605 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 43605 Payer coverage policies that name 43605 43605 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Upper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (0738) covered if criteria are met Oct 29, 2025 payer document
Medicaid fee-for-service AZ: $866.79 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $448.96 (chp_plus, non-facility), effective Jul 1, 2026 FL: $622.67 (physician, non-facility), effective Jan 1, 2026 IL: $599.35 (practitioner), effective Jul 1, 2026 IN: $635.94 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $470.48 (default, Exempt Physician), effective Aug 1, 2024 KY: $431.36 (physician, facility), effective Jan 1, 2026 LA: $682.41 (professional), effective Jul 1, 2025 MA: $612.88 (physician_surgery), effective May 1, 2024 MS: $663.17 (comprehensive), effective Jul 1, 2026 ND: $820.07 (physician), effective Aug 1, 2026 NE: $229.33 (physician, non-facility), effective Jul 1, 2026 NY: $374.32 (physician_surgery, facility), effective Jul 1, 2026 OH: $447.79 (physician), effective Jan 1, 2024 OK: $701.20 (physician, non-facility), effective Jul 1, 2026 TX: $99.03 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $693.58 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $463.04 (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.