46604 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 46604

Payer coverage policies that name 46604

46604 appears in 1 coverage policy from Aetna.

Medicaid fee-for-service

• AZ: $358.52 (asc), effective Oct 1, 2026
• CO: $52.53 (chp_plus, non-facility), effective Jul 1, 2026
• FL: $668.89 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
• IL: $45.40 (practitioner), effective Apr 1, 2024
• IN: $50.48 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
• KS: $200.00 (asc, facility), effective Aug 1, 1982
• KY: $639.61 (asc), effective Jan 1, 2026
• LA: $482.83 (professional), effective Jul 1, 2025
• MA: $431.31 (asc), effective May 1, 2026
• MS: $443.02 (comprehensive, facility), effective Oct 1, 2025
• ND: $632.64 (physician, facility), effective Aug 1, 2026
• NE: $17.06 (physician, facility), effective Jul 1, 2026
• NY: $31.62 (physician_surgery, facility), effective Jul 1, 2026
• OH: $50.11 (physician, facility), effective Jan 1, 2024
• OK: $54.92 (physician, facility), effective Jul 1, 2026
• TX: $429.26 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
• VA: $54.11 (medical, facility), effective Jul 1, 2026
• VT: $929.15 (outpatient_hospital_opps), effective Feb 1, 2026
• WA: $36.88 (physician, facility), effective Jul 1, 2026
• WY: $529.20 (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.