49553 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 49553

Medicaid fee-for-service

  • AZ: $1221.04 (asc), effective Oct 1, 2026
  • CO: $501.76 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $636.23 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025
  • IL: $445.94 (practitioner), effective Apr 1, 2024
  • IN: $479.57 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $435.00 (asc, facility), effective Jan 1, 1994
  • KY: $1702.62 (asc), effective Jan 1, 2026
  • LA: $265.13 (asc), effective Jul 1, 2012
  • MA: $1170.63 (asc), effective May 1, 2026
  • MS: $1348.14 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1003.70 (physician, facility), effective Aug 1, 2026
  • NE: $785.00 (asc), effective Jul 1, 2024
  • NY: $283.89 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $365.58 (physician), effective Jan 1, 2024
  • OK: $1553.34 (asc), effective Jan 1, 2026
  • TX: $1151.54 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $527.49 (medical), effective Jul 1, 2026
  • VT: $2780.04 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1583.39 (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.