Payer policies › CPT 4902049020 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 49020 Medicaid fee-for-service AZ: $1629.33 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $1251.62 (chp_plus, non-facility), effective Jul 1, 2026 FL: $1598.06 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $1120.52 (practitioner), effective Apr 1, 2024 IN: $1199.75 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $400.00 (asc, facility), effective Aug 1, 1982 KY: $417.25 (physician, facility), effective Jan 1, 2026 LA: $1299.08 (professional), effective Jul 1, 2025 MA: $1168.93 (physician_surgery), effective May 1, 2024 MS: $1238.45 (comprehensive), effective Jul 1, 2026 ND: $1531.26 (physician), effective Aug 1, 2026 NE: $1067.04 (physician, non-facility), effective Jul 1, 2026 NY: $716.29 (physician_surgery, facility), effective Jul 1, 2026 OH: $858.78 (physician), effective Jan 1, 2024 OK: $1308.16 (physician, non-facility), effective Jul 1, 2026 TX: $1190.84 (physician, Physician, facility), effective Sep 1, 2026 VA: $1289.06 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $860.71 (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.