Payer policies › CPT 4921549215 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 49215 Medicaid fee-for-service AZ: $2256.59 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $1728.20 (chp_plus, non-facility), effective Jul 1, 2026 FL: $2212.86 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $1554.03 (practitioner), effective Apr 1, 2024 IN: $1668.79 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $435.00 (asc, facility), effective Aug 1, 1982 KY: $884.30 (physician, facility), effective Jan 1, 2026 LA: $1806.92 (professional), effective Jul 1, 2025 MA: $1613.17 (physician_surgery), effective May 1, 2024 MS: $1676.55 (comprehensive), effective Jul 1, 2026 ND: $2071.96 (physician), effective Aug 1, 2026 NE: $1348.62 (physician, non-facility), effective Jul 1, 2026 NY: $1006.50 (physician_surgery, facility), effective Jul 1, 2026 OH: $1215.01 (physician), effective Jan 1, 2024 OK: $1769.10 (physician, non-facility), effective Jul 1, 2026 TX: $236.01 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $1735.53 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $1158.83 (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.