Payer policies › CPT 5913659136 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 59136 Medicaid fee-for-service AZ: $930.03 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $727.75 (chp_plus, non-facility), effective Jul 1, 2026 FL: $628.39 (physician, non-facility), effective Jan 1, 2026 IL: $645.56 (practitioner), effective Apr 1, 2024 IN: $667.68 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $546.22 (default, Exempt Physician), effective Aug 1, 2024 KY: $456.82 (physician, facility), effective Jan 1, 2026 LA: $693.00 (professional), effective Feb 1, 2013 MA: $942.69 (physician_surgery), effective May 1, 2024 MS: $667.56 (comprehensive), effective Jul 1, 2026 ND: $808.81 (physician), effective Aug 1, 2026 NE: $340.30 (physician, non-facility), effective Jul 1, 2026 NY: $421.91 (physician_surgery, facility), effective Jul 1, 2026 OH: $518.18 (physician), effective Jan 1, 2024 OK: $705.86 (physician, non-facility), effective Jul 1, 2026 TX: $112.33 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2026 VA: $820.33 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $893.58 (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.