57180 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 57180

Payer coverage policies that name 57180

57180 appears in 2 coverage policies from Aetna.

Medicaid fee-for-service

• AZ: $61.71 (asc), effective Oct 1, 2026
• CO: $117.84 (chp_plus, non-facility), effective Jul 1, 2026
• FL: $83.87 (physician, facility), effective Jan 1, 2026
• IL: $82.59 (practitioner), effective Apr 1, 2024
• IN: $92.66 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
• KS: $190.84 (asc, facility), effective Aug 1, 1982
• KY: $109.05 (asc), effective Jan 1, 2026
• LA: $182.30 (asc), effective Jul 1, 2012
• MA: $71.32 (asc), effective May 1, 2026
• MS: $87.02 (comprehensive, facility), effective Oct 1, 2025
• ND: $64.29 (physician, facility), effective Aug 1, 2026
• NE: $413.00 (asc), effective Jul 1, 2024
• NY: $50.99 (midwife, facility), effective Jul 1, 2026
• OH: $62.81 (physician, facility), effective Jan 1, 2024
• OK: $99.48 (asc), effective Jan 1, 2026
• TX: $70.52 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
• VA: $108.52 (medical, facility), effective Jul 1, 2026
• VT: $156.98 (outpatient_hospital_opps), effective Feb 1, 2026
• WA: $308.28 (asc), effective Jul 1, 2026
• WY: $89.41 (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.