48102 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 48102

Payer coverage policies that name 48102

48102 appears in 1 coverage policy from Aetna.

Medicaid fee-for-service

• AZ: $450.44 (asc), effective Oct 1, 2026
• CO: $93.53 (chp_plus, non-facility), effective Jul 1, 2026
• FL: $160.16 (physician, facility), effective Jan 1, 2026
• IL: $158.98 (practitioner), effective Apr 1, 2024
• IN: $180.88 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
• KS: $100.00 (asc, facility), effective Aug 1, 1982
• KY: $724.34 (asc), effective Jan 1, 2026
• LA: $182.30 (asc), effective Jul 1, 2012
• MA: $489.93 (asc), effective May 1, 2026
• MS: $566.62 (comprehensive, facility), effective Oct 1, 2025
• ND: $427.00 (physician, facility), effective Aug 1, 2026
• NE: $413.00 (asc), effective Jul 1, 2024
• NY: $125.63 (physician_surgery, facility), effective Jul 1, 2026
• OH: $209.54 (physician, facility), effective Jan 1, 2024
• OK: $660.83 (asc), effective Jan 1, 2026
• TX: $486.45 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
• VA: $176.50 (medical, facility), effective Jul 1, 2026
• VT: $1282.40 (outpatient_hospital_opps), effective Feb 1, 2026
• WA: $308.28 (asc), effective Jul 1, 2026
• WY: $730.40 (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.