55709 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 55709

Payer coverage policies that name 55709

55709 appears in 1 coverage policy from Aetna.

Medicaid fee-for-service

Prior authorization required or conditional in KY.

• AZ: $1171.31 (asc), effective Oct 1, 2026
• CO: $478.13 (chp_plus, non-facility), effective Jul 1, 2026
• FL: $126.77 (physician, facility), effective Jan 1, 2026
• IL: $117.12 (practitioner), effective Jan 1, 2026
• IN: $125.59 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
• KY: $1681.93 (asc), effective Jan 1, 2026
• LA: $182.30 (asc), effective Jan 1, 2026
• MS: $1378.42 (comprehensive, facility), effective Jan 1, 2026
• ND: $991.50 (physician, facility), effective Aug 1, 2026
• NY: $87.35 (physician_surgery, facility), effective Jul 1, 2026
• OH: $127.63 (code_changes, facility), effective Jan 1, 2026
• OK: $145.57 (physician, facility), effective Jul 1, 2026
• TX: $1378.42 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jan 1, 2026
• VA: $143.29 (medical, facility), effective Jan 1, 2026
• VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
• WA: $339.40 (asc), effective Jul 1, 2026
• WY: $1558.88 (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.