Payer policies › CPT 4812048120 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 48120 Medicaid fee-for-service AZ: $1139.10 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $876.51 (chp_plus, non-facility), effective Jul 1, 2026 FL: $814.38 (physician, non-facility), effective Jan 1, 2026 IL: $787.11 (practitioner), effective Apr 1, 2024 IN: $835.52 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $375.66 (default, Exempt Physician), effective Aug 1, 2024 KY: $686.31 (physician, facility), effective Jan 1, 2026 LA: $181.86 (professional), effective Jul 1, 2025 MA: $818.79 (physician_surgery), effective May 1, 2024 MS: $868.82 (comprehensive), effective Jul 1, 2026 ND: $1070.15 (physician), effective Aug 1, 2026 NE: $1430.12 (physician, non-facility), effective Jul 1, 2026 NY: $496.38 (physician_surgery, facility), effective Jul 1, 2026 OH: $688.62 (physician), effective Jan 1, 2024 OK: $918.17 (physician, non-facility), effective Jul 1, 2026 TX: $123.35 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $907.12 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $604.07 (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.