Payer policies › CPT 6216462164 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 62164 Payer coverage policies that name 62164 62164 appears in 5 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Grid Monitoring and Intraoperative Electroencephalography (0289) listed, no stance (range 62160-62165) Apr 17, 2026 payer document Aetna Intraoperative Neurophysiological Monitoring (0697) covered if criteria are met (range 62160-62165) Jun 19, 2026 payer document Aetna Intravenous Iron Therapy (0575) listed, no stance (range 61000-64999) Jul 1, 2026 payer document Aetna Respiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479) listed, no stance (range 61000-64999) Jul 9, 2026 payer document Aetna Thermal Perfusion Probe for Monitoring Regional Cerebral Blood Flow (0703) listed, no stance (range 61000-64999) Nov 24, 2025 payer document
Medicaid fee-for-service AZ: $2156.52 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $1650.32 (chp_plus, non-facility), effective Jul 1, 2026 FL: $1602.01 (physician, non-facility), effective Jan 1, 2026 IL: $1526.50 (practitioner), effective Apr 1, 2024 IN: $1544.57 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $1178.95 (default, Exempt Physician), effective Aug 1, 2024 KY: $1278.69 (physician, facility), effective Jan 1, 2026 LA: $1726.49 (professional), effective Jul 1, 2025 MA: $1546.47 (physician_surgery), effective May 1, 2024 MS: $1671.60 (comprehensive), effective Jul 1, 2026 ND: $2044.93 (physician), effective Aug 1, 2026 NE: $1570.92 (physician, non-facility), effective Jul 1, 2026 NY: $924.35 (physician_surgery, facility), effective Jul 1, 2026 OH: $1228.04 (physician), effective Jan 1, 2024 OK: $1774.27 (physician, non-facility), effective Jul 1, 2026 TX: $263.92 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2025 VA: $1784.43 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $1181.57 (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.