43870 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 43870

Payer coverage policies that name 43870

43870 appears in 2 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaAbdominoplasty, Suction Lipectomy, and Ventral Hernia Repair (0211)listed, no stance (range 43843-43888)Aug 18, 2026payer document
AetnaUpper Gastrointestinal Endoscopy and Gastrointestinal Biopsy (0738)listed, no stance (range 43842-43888)Oct 29, 2025payer document

Medicaid fee-for-service

Prior authorization required or conditional in ND.

  • AZ: $1501.24 (asc), effective Oct 1, 2026
  • CO: $561.45 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $718.91 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IL: $498.51 (practitioner), effective Apr 1, 2024
  • IN: $535.84 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $300.00 (asc, facility), effective Aug 1, 1982
  • KY: $1939.17 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $1110.22 (asc), effective May 1, 2026
  • MS: $1500.65 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1143.14 (physician, facility), effective Aug 1, 2026
  • NE: $413.00 (asc), effective Jul 1, 2024
  • NY: $317.03 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $376.59 (physician), effective Jan 1, 2024
  • OK: $1769.15 (asc), effective Jan 1, 2026
  • TX: $1119.26 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $583.62 (medical), effective Jul 1, 2026
  • VT: $2993.62 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1705.03 (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.