48001 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 48001

Medicaid fee-for-service

  • AZ: $2346.20 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $741.17 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $1655.52 (physician, non-facility), effective Jan 1, 2026
  • IL: $1631.36 (practitioner), effective Apr 1, 2024
  • IN: $1718.89 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $819.79 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $719.99 (physician, facility), effective Jan 1, 2026
  • LA: $1881.42 (professional), effective Jul 1, 2025
  • MA: $1680.65 (physician_surgery), effective May 1, 2024
  • MS: $1772.68 (comprehensive), effective Jul 1, 2026
  • ND: $2161.71 (physician), effective Aug 1, 2026
  • NE: $309.22 (physician, non-facility), effective Jul 1, 2026
  • NY: $1044.09 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $1259.81 (physician), effective Jan 1, 2024
  • OK: $1871.68 (physician, non-facility), effective Jul 1, 2026
  • TX: $250.76 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026
  • VA: $1844.04 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $1220.75 (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.