Payer policies › CPT 4412144121 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 44121 Payer coverage policies that name 44121 44121 appears in 2 coverage policies from Aetna, Blue Cross NC.
Payer Policy Role in policy Reviewed Document Aetna Intravenous Iron Therapy (0575) listed, no stance (range 44005-44799) Jul 1, 2026 payer document Blue Cross NC Small Bowel, Small Bowel with Liver, or Multivisceral Transplant listed, no stance Mar 1, 2026 payer document
Medicaid fee-for-service AZ: $243.37 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $186.67 (chp_plus, non-facility), effective Jul 1, 2026 FL: $241.22 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $242.74 (practitioner), effective Apr 1, 2024 IN: $178.79 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $87.86 (default, Exempt Physician), effective Aug 1, 2024 KY: $205.93 (physician, facility), effective Jan 1, 2026 LA: $39.25 (professional), effective Jul 1, 2025 MA: $173.76 (physician_surgery), effective May 1, 2024 MS: $181.89 (comprehensive), effective Jul 1, 2026 ND: $219.29 (physician), effective Aug 1, 2026 NE: $481.64 (physician, non-facility), effective Jul 1, 2026 NY: $114.57 (physician_surgery, facility), effective Jul 1, 2026 OH: $193.96 (physician), effective Jan 1, 2024 OK: $191.58 (physician, non-facility), effective Jul 1, 2026 TX: $25.49 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $187.50 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $123.45 (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.