Payer policies › CPT 5413054130 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 54130 1 of 1 payer prior-auth lists that name 54130 require prior authorization or set conditions: Humana.
Medicaid fee-for-service AZ: $1222.79 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $971.48 (chp_plus, non-facility), effective Jul 1, 2026 FL: $831.01 (physician, non-facility), effective Jan 1, 2026 IL: $815.26 (practitioner), effective Apr 1, 2024 IN: $921.13 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $456.65 (default, Exempt Physician), effective Aug 1, 2024 KY: $980.46 (physician, facility), effective Jan 1, 2026 LA: $1021.92 (professional), effective Feb 1, 2013 MA: $872.45 (physician_surgery), effective May 1, 2024 MS: $906.89 (comprehensive), effective Jul 1, 2026 ND: $1139.99 (physician), effective Aug 1, 2026 NE: $414.28 (physician, non-facility), effective Jul 1, 2026 NY: $605.12 (physician_surgery, facility), effective Jul 1, 2026 OH: $906.46 (physician), effective Jan 1, 2000 OK: $954.69 (physician, non-facility), effective Jul 1, 2026 TX: $140.63 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2026 VA: $925.64 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $625.28 (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.