47534 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 47534

Payer coverage policies that name 47534

47534 appears in 3 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaEndoscopic Ultrasonography (0446)listed, no stanceJul 22, 2026payer document
AetnaPancreaticoduodenectomy (Whipple Resection) (0365)listed, no stanceMay 22, 2026payer document
AetnaProcalcitonin (PCT) (0771)listed, no stance (range 47533-47537)Nov 13, 2025payer document

Medicaid fee-for-service

  • AZ: $1221.04 (asc), effective Oct 1, 2026
  • CO: $286.04 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $248.18 (physician, facility), effective Jan 1, 2026
  • IL: $252.68 (practitioner), effective Jan 1, 2016
  • IN: $280.58 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $791.32 (asc, facility), effective Jan 1, 2016
  • KY: $1702.62 (asc), effective Jan 1, 2026
  • LA: $265.13 (asc), effective Jan 1, 2016
  • MA: $1170.63 (asc), effective May 1, 2026
  • MS: $1348.14 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1003.70 (physician, facility), effective Aug 1, 2026
  • NE: $1662.00 (asc), effective Jul 1, 2024
  • NY: $226.54 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $330.63 (physician, facility), effective Jan 1, 2016
  • OK: $286.85 (physician, facility), effective Jul 1, 2026
  • TX: $1151.54 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $274.60 (medical, facility), effective Jul 1, 2026
  • VT: $2780.04 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1583.39 (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.