Payer policies › CPT 4363543635 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 43635 Payer coverage policies that name 43635 43635 appears in 4 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Headaches: Invasive Procedures (0707) not covered (range 43631-43635) Jul 23, 2026 payer document Aetna Infertility (0327) not covered (range 43631-43635) Jul 16, 2026 payer document Aetna Obesity Surgery (0157)Sleeve gastrectomy with SIPS, Laparoscopic single-anastomosis duodeno-ileal bypass with gastric plication not covered Jul 21, 2026 payer document Aetna Respiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479) listed, no stance (range 43631-43635) Jul 9, 2026 payer document
Medicaid fee-for-service AZ: $113.67 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $89.67 (chp_plus, non-facility), effective Jul 1, 2026 FL: $111.94 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $113.66 (practitioner), effective Apr 1, 2024 IN: $83.34 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $74.39 (default, Exempt Physician), effective Aug 1, 2024 KY: $95.73 (physician, facility), effective Jan 1, 2026 LA: $91.68 (professional), effective Jul 1, 2025 MA: $81.26 (physician_surgery), effective May 1, 2024 MS: $84.62 (comprehensive), effective Jul 1, 2026 ND: $101.76 (physician), effective Aug 1, 2026 NE: $340.30 (physician, non-facility), effective Jul 1, 2026 NY: $53.05 (physician_surgery, facility), effective Jul 1, 2026 OH: $89.84 (physician), effective Jan 1, 2024 OK: $89.14 (physician, non-facility), effective Jul 1, 2026 TX: $12.48 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $87.38 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $57.33 (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.