Payer policies › CPT 4940549405 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 49405 Payer coverage policies that name 49405 49405 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Ultrasound Guidance – Selected Indications (0952) covered if criteria are met Apr 27, 2026 payer document
Medicaid fee-for-service AZ: $450.44 (asc), effective Oct 1, 2026 CO: $151.12 (chp_plus, non-facility), effective Jul 1, 2026 FL: $131.45 (physician, facility), effective Jan 1, 2026 IL: $131.54 (practitioner), effective Jan 1, 2014 IN: $148.78 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $381.13 (default, Exempt Physician), effective Aug 1, 2024 KY: $174.18 (physician, facility), effective Jan 1, 2026 LA: $689.32 (professional), effective Jan 1, 2014 MA: $140.36 (physician_surgery, facility), effective May 1, 2024 MS: $1254.25 (comprehensive), effective Jul 1, 2026 ND: $932.35 (physician), effective Aug 1, 2026 NE: $444.60 (physician, non-facility), effective Jul 1, 2026 NY: $115.94 (physician_surgery, facility), effective Jul 1, 2026 OH: $165.26 (physician, facility), effective Jan 1, 2024 OK: $150.88 (physician, facility), effective Jul 1, 2026 TX: $133.39 (physician, Physician, facility), effective Sep 1, 2026 VA: $144.39 (medical, facility), effective Jul 1, 2026 VT: $1282.40 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $96.70 (physician, facility), 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.