Payer policies › CPT 4990549905 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 49905 Payer coverage policies that name 49905 49905 appears in 2 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Lymphedema (0069) not covered Feb 25, 2026 payer document Aetna Pancreaticoduodenectomy (Whipple Resection) (0365) not covered May 22, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in FL.
AZ: $355.99 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $273.75 (chp_plus, non-facility), effective Jul 1, 2026 FL: $244.96 (physician, non-facility), effective Jan 1, 2026 IL: $354.70 (practitioner), effective Apr 1, 2024 IN: $262.28 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $150.73 (default, Exempt Physician), effective Aug 1, 2024 KY: $303.37 (physician, facility), effective Jan 1, 2026 LA: $287.33 (professional), effective Jul 1, 2025 MA: $254.80 (physician_surgery), effective May 1, 2024 MS: $265.30 (comprehensive), effective Jul 1, 2026 ND: $321.05 (physician), effective Aug 1, 2026 NE: $466.82 (physician, non-facility), effective Jul 1, 2026 NY: $167.74 (physician_surgery, facility), effective Jul 1, 2026 OH: $273.12 (physician), effective Jan 1, 2000 OK: $279.33 (physician, non-facility), effective Jul 1, 2026 TX: $37.10 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2026 VA: $272.86 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $180.02 (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.