49422 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 49422

Payer coverage policies that name 49422

49422 appears in 1 coverage policy from Regence.

PayerPolicyRole in policyReviewedDocument
RegenceSurgical Site of Care – Hospital Outpatient (Utilization Management 19)listed, no stanceMay 1, 2026payer document

Medicaid fee-for-service

  • AZ: $1188.60 (asc), effective Oct 1, 2026
  • CO: $171.82 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $385.14 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IL: $222.61 (practitioner), effective Apr 1, 2024
  • IN: $164.58 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KY: $1584.96 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $1140.05 (asc), effective May 1, 2026
  • MS: $1270.95 (comprehensive, facility), effective Oct 1, 2025
  • ND: $934.34 (physician, facility), effective Aug 1, 2026
  • NE: $413.00 (asc), effective Jul 1, 2024
  • NY: $180.12 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $227.36 (physician), effective Jan 1, 2024
  • OK: $1446.00 (asc), effective Jan 1, 2026
  • TX: $1118.22 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $174.77 (medical), effective Jul 1, 2026
  • VT: $2451.66 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1396.35 (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.