Payer policies › CPT 6216562165 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 62165 Payer coverage policies that name 62165 62165 appears in 6 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Electroretinography (0854) listed, no stance Dec 24, 2025 payer 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: $1558.55 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $1203.34 (chp_plus, non-facility), effective Jul 1, 2026 FL: $1089.22 (physician, non-facility), effective Jan 1, 2026 IL: $1198.70 (practitioner), effective Jul 1, 2026 IN: $1137.92 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $1500.00 (asc, facility), effective Jan 1, 2003 KY: $1002.03 (physician, facility), effective Jan 1, 2026 LA: $1242.97 (professional), effective Jul 1, 2025 MA: $1126.36 (physician_surgery), effective May 1, 2024 MS: $1155.39 (comprehensive), effective Jul 1, 2026 ND: $1426.87 (physician), effective Aug 1, 2026 NE: $250.04 (physician, non-facility), effective Jul 1, 2026 NY: $714.20 (physician_surgery, facility), effective Jul 1, 2026 OH: $961.34 (physician), effective Jan 1, 2024 OK: $1222.76 (physician, non-facility), effective Jul 1, 2026 TX: $1228.27 (physician, Physician, facility), effective Mar 1, 2025 VA: $1213.25 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $808.74 (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.