Payer policies › CPT 5405054050 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 54050 Payer coverage policies that name 54050 54050 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Benign Skin Lesion Removal (0633) covered if criteria are met (range 54050-54065) Sep 9, 2026 payer document
Medicaid fee-for-service AZ: $38.01 (outpatient_hospital, RF133), effective Oct 1, 2025 CO: $117.76 (chp_plus, non-facility), effective Jul 1, 2026 FL: $75.33 (physician, facility), effective Jan 1, 2026 IL: $71.74 (practitioner), effective Apr 1, 2024 IN: $83.74 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $250.00 (asc, facility), effective Aug 1, 1982 KY: $0.00 (asc), effective Jan 1, 2026 LA: $113.70 (professional), effective Jul 1, 2025 MA: $0.00 (asc), effective May 1, 2026 MS: $117.86 (comprehensive), effective Jul 1, 2026 ND: $161.09 (physician), effective Aug 1, 2026 NE: $29.71 (physician, facility), effective Jul 1, 2026 NY: $48.23 (physician_surgery, facility), effective Jul 1, 2026 OH: $80.52 (physician, facility), effective Jan 1, 2024 OK: $84.70 (physician, facility), effective Jul 1, 2026 TX: $113.36 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Mar 1, 2026 VA: $83.91 (medical, facility), effective Jul 1, 2026 VT: $315.64 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $58.48 (physician, facility), effective Jul 1, 2026 WY: $179.77 (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.