Payer policies › CPT 4364043640 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 43640 Medicaid fee-for-service AZ: $1220.69 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $936.88 (chp_plus, non-facility), effective Jul 1, 2026 FL: $872.31 (physician, non-facility), effective Jan 1, 2026 IL: $842.21 (practitioner), effective Apr 1, 2024 IN: $895.23 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $662.43 (default, Exempt Physician), effective Aug 1, 2024 KY: $720.24 (physician, facility), effective Jan 1, 2026 LA: $972.91 (professional), effective Jul 1, 2025 MA: $875.71 (physician_surgery), effective May 1, 2024 MS: $930.14 (comprehensive), effective Jul 1, 2026 ND: $1147.50 (physician), effective Aug 1, 2026 NE: $1511.64 (physician, non-facility), effective Jul 1, 2026 NY: $527.65 (physician_surgery, facility), effective Jul 1, 2026 OH: $715.27 (physician), effective Jan 1, 2024 OK: $983.14 (physician, non-facility), effective Jul 1, 2026 TX: $138.74 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $971.64 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $647.64 (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.