Payer policies › CPT 4961149611 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 49611 Medicaid fee-for-service AZ: $631.09 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $448.96 (chp_plus, non-facility), effective Jul 1, 2026 FL: $518.85 (pediatric_surgery, pediatric surgeon), effective Jan 1, 2025 IL: $449.50 (practitioner), effective Jul 1, 2026 IN: $463.45 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $258.55 (default, Exempt Physician), effective Aug 1, 2024 KY: $497.57 (physician, facility), effective Jan 1, 2026 LA: $99.84 (professional), effective Jul 1, 2025 MA: $454.58 (physician_surgery), effective May 1, 2024 MS: $486.50 (comprehensive), effective Jul 1, 2026 ND: $609.42 (physician), effective Aug 1, 2026 NE: $195.30 (physician, non-facility), effective Jul 1, 2026 NY: $289.50 (physician_surgery, facility), effective Jul 1, 2026 OH: $494.25 (physician), effective Jan 1, 2024 OK: $515.14 (physician, non-facility), effective Jul 1, 2026 TX: $73.00 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $511.28 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $343.79 (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.