Payer policies › CPT 4495544955 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 44955 Medicaid fee-for-service AZ: $1786.44 (outpatient_hospital), effective Oct 1, 2013 CO: $65.06 (chp_plus, non-facility), effective Jul 1, 2026 FL: $83.70 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $83.69 (practitioner), effective Apr 1, 2024 IN: $62.31 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $500.00 (asc, facility), effective Aug 1, 1982 KY: $45.00 (asc), effective Jan 1, 2026 LA: $13.59 (professional), effective Jul 1, 2025 MA: $60.60 (physician_surgery), effective May 1, 2024 MS: $62.88 (comprehensive), effective Jul 1, 2026 ND: $76.22 (physician), effective Aug 1, 2026 NE: $26.67 (physician, non-facility), effective Jul 1, 2026 NY: $161.60 (physician_surgery, facility), effective Jul 1, 2026 OH: $71.50 (physician), effective Jan 1, 2010 OK: $66.24 (physician, non-facility), effective Jul 1, 2026 TX: $8.81 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $64.81 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $42.81 (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.