Payer policies › CPT 4412844128 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 44128 Payer coverage policies that name 44128 44128 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Intravenous Iron Therapy (0575) listed, no stance (range 44005-44799) Jul 1, 2026 payer document
Medicaid fee-for-service AZ: $245.46 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $193.31 (chp_plus, non-facility), effective Jul 1, 2026 FL: $242.58 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $175.20 (practitioner), effective Jul 1, 2026 IN: $179.49 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $142.19 (default, Exempt Physician), effective Aug 1, 2024 KY: $185.26 (physician, facility), effective Jan 1, 2026 LA: $198.24 (professional), effective Jul 1, 2025 MA: $175.03 (physician_surgery), effective May 1, 2024 MS: $183.11 (comprehensive), effective Jul 1, 2026 ND: $219.66 (physician), effective Aug 1, 2026 NE: $326.04 (physician, non-facility), effective Jul 1, 2026 NY: $116.17 (physician_surgery, facility), effective Jul 1, 2026 OH: $185.58 (physician), effective Jan 1, 2024 OK: $192.92 (physician, non-facility), effective Jul 1, 2026 TX: $27.02 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $189.24 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $124.22 (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.