Payer policies › CPT 4380043800 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 43800 2 of 2 payer prior-auth lists that name 43800 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, HealthSpring.
Payer coverage policies that name 43800 43800 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Obesity Surgery (0157) listed, no stance Jul 21, 2026 payer document
Recent prior-auth changes Apr 1, 2026: PA removed, Blue Cross and Blue Shield of Illinois Apr 1, 2026: PA removed, Blue Cross and Blue Shield of Illinois Jan 1, 2026: conditions changed, Blue Cross and Blue Shield of Illinois Medicaid fee-for-service Prior authorization required or conditional in ND.
AZ: $952.22 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $731.08 (chp_plus, non-facility), effective Jul 1, 2026 FL: $935.63 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $699.20 (practitioner), effective Jul 1, 2026 IN: $699.15 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $400.00 (asc, facility), effective Aug 1, 1982 KY: $495.57 (physician, facility), effective Jan 1, 2026 LA: $759.79 (professional), effective Jul 1, 2025 MA: $682.70 (physician_surgery), effective May 1, 2024 MS: $723.70 (comprehensive), effective Jul 1, 2026 ND: $895.92 (physician), effective Aug 1, 2026 NE: $247.09 (physician, non-facility), effective Jul 1, 2026 NY: $419.48 (physician_surgery, facility), effective Jul 1, 2026 OH: $502.78 (physician), effective Jan 1, 2024 OK: $765.10 (physician, non-facility), effective Jul 1, 2026 TX: $102.62 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $754.63 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $503.93 (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.