Payer policies › CPT 5962259622 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 59622 Payer coverage policies that name 59622 59622 appears in 4 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross NC, BlueCross BlueShield of South Carolina.
Payer Policy Role in policy Reviewed Document Aetna Home Births (0329) not covered (range 59610-59622) May 21, 2026 payer document Blue Cross & Blue Shield of Mississippi Medically Indicated Earlyterm Deliveries Prior To 39 Weeks (L.4.01.400) listed, no stance payer document Blue Cross NC Guidelines for Global Maternity Reimbursement listed, no stance Nov 1, 2024 payer document BlueCross BlueShield of South Carolina Maternity/Obstetrical Care Benefits (CAM 366)59020 | FETAL CONTRACTION STRESS TEST listed, no stance Feb 1, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in WA.
AZ: $1634.95 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $1111.88 (chp_plus, non-facility), effective Jul 1, 2026 FL: $1029.60 (physician, non-facility), effective Jan 1, 2026 IL: $1070.45 (practitioner), effective Apr 1, 2009 IN: $1022.28 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $705.68 (default, Exempt Physician), effective Jan 1, 1996 KY: $45.00 (asc), effective Jan 1, 2026 LA: $940.56 (professional), effective Feb 1, 2013 MA: $1402.33 (physician_surgery), effective May 1, 2024 MS: $1049.36 (comprehensive), effective Jul 1, 2026 ND: $1253.39 (physician), effective Aug 1, 2026 NE: $1565.33 (physician, non-facility), effective Jul 1, 2026 NY: $1164.69 (physician_special_programs), effective Apr 1, 2022 OH: $926.93 (physician), effective Jan 1, 2024 OK: $1107.14 (physician, non-facility), effective Jul 1, 2026 TX: $164.08 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), facility), effective Mar 1, 2026 VA: $1282.55 (medical), effective Jul 1, 2026 VT: $966.39 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $1366.62 (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.