61304 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 61304

Payer coverage policies that name 61304

61304 appears in 8 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaGrid Monitoring and Intraoperative Electroencephalography (0289)listed, no stance (range 61304-61576)Apr 17, 2026payer document
AetnaInpatient Admission Prior to Surgery (Preop Days) (0255)listed, no stance (range 61304-61576)May 13, 2026payer document
AetnaIntraoperative Neurophysiological Monitoring (0697)covered if criteria are met (range 61304-61576)Jun 19, 2026payer document
AetnaIntraoperative Neurophysiological Monitoring (0697)covered if criteria are metJun 19, 2026payer document
AetnaIntravenous Iron Therapy (0575)listed, no stance (range 61000-64999)Jul 1, 2026payer document
AetnaNerve Blocks (0863)listed, no stance (range 61304-61576)Jul 23, 2026payer document
AetnaRespiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479)listed, no stance (range 61000-64999)Jul 9, 2026payer document
AetnaSafety Items (0623)listed, no stance (range 61304-61619)Sep 23, 2026payer document
AetnaThermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (0703)listed, no stance (range 61000-64999)Nov 24, 2025payer document

Medicaid fee-for-service

  • AZ: $1687.56 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $1288.70 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $1251.32 (physician, non-facility), effective Jan 1, 2026
  • IL: $1194.76 (practitioner), effective Apr 1, 2024
  • IN: $1209.60 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $1500.00 (asc, facility), effective Aug 1, 1982
  • KY: $1419.68 (physician, facility), effective Jan 1, 2026
  • LA: $1352.21 (professional), effective Jul 1, 2025
  • MA: $1207.17 (physician_surgery), effective May 1, 2024
  • MS: $1306.94 (comprehensive), effective Jul 1, 2026
  • ND: $1596.22 (physician), effective Aug 1, 2026
  • NE: $2593.50 (physician, non-facility), effective Jul 1, 2026
  • NY: $769.72 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $1296.47 (physician), effective Jan 1, 2024
  • OK: $1387.04 (physician, non-facility), effective Jul 1, 2026
  • TX: $196.70 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2025
  • VA: $1393.81 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $922.06 (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.