46754 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 46754

Medicaid fee-for-service

  • AZ: $913.45 (asc), effective Oct 1, 2026
  • CO: $149.66 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $186.52 (physician, facility), effective Jan 1, 2026
  • IL: $163.60 (practitioner), effective Apr 1, 2024
  • IN: $188.73 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $154.47 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $1398.34 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $935.17 (asc), effective May 1, 2026
  • MS: $1118.38 (comprehensive, facility), effective Oct 1, 2025
  • ND: $824.33 (physician, facility), effective Aug 1, 2026
  • NE: $552.00 (asc), effective Jul 1, 2024
  • OH: $122.85 (physician, facility), effective Jan 1, 2024
  • OK: $1275.74 (asc), effective Jan 1, 2026
  • TX: $939.93 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $207.75 (medical, facility), effective Jul 1, 2026
  • VT: $2155.19 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1227.50 (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.