61316 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 61316

Payer coverage policies that name 61316

61316 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
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: $88.91 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025
  • CO: $66.60 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $62.09 (physician, non-facility), effective Jan 1, 2026
  • IN: $63.19 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KY: $65.84 (physician, facility), effective Jan 1, 2026
  • LA: $71.87 (professional), effective Jul 1, 2025
  • MA: $63.17 (physician_surgery), effective May 1, 2024
  • MS: $65.48 (comprehensive), effective Jul 1, 2026
  • ND: $77.35 (physician), effective Aug 1, 2026
  • NE: $81.50 (physician, non-facility), effective Jul 1, 2026
  • NY: $42.02 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $63.20 (physician), effective Jan 1, 2024
  • OK: $69.27 (physician, non-facility), effective Jul 1, 2026
  • TX: $73.82 (physician, Physician, facility), effective Mar 1, 2025
  • VA: $69.16 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $44.91 (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.