Payer policies › CPT 4365243652 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 43652 Medicaid fee-for-service Prior authorization required or conditional in ND, WV.
AZ: $1984.28 (asc), effective Oct 1, 2026 CO: $580.66 (chp_plus, non-facility), effective Jul 1, 2026 FL: $569.68 (physician, non-facility), effective Jan 1, 2026 IL: $541.21 (practitioner), effective Apr 1, 2024 IN: $578.27 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $435.00 (asc, facility), effective Jan 1, 2000 KY: $2958.68 (asc), effective Jan 1, 2026 LA: $625.86 (professional), effective Jul 1, 2025 MA: $566.14 (physician_surgery), effective May 1, 2024 MS: $605.44 (comprehensive), effective Jul 1, 2026 ND: $752.86 (physician), effective Aug 1, 2026 NE: $442.39 (physician, non-facility), effective Jul 1, 2026 NY: $351.33 (physician_surgery, facility), effective Jul 1, 2026 OH: $530.91 (physician), effective Jan 1, 2024 OK: $640.56 (physician, non-facility), effective Jul 1, 2026 TX: $90.60 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $634.55 (medical), effective Jul 1, 2026 VT: $4694.12 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $424.82 (physician, facility), effective Jul 1, 2026 WY: $2673.55 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.