Payer policies › CPT 6370463704 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 63704 Payer coverage policies that name 63704 63704 appears in 5 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Intraoperative Neurophysiological Monitoring (0697) not covered (range 62263-63746) Jun 19, 2026 payer document Aetna Intravenous Iron Therapy (0575) listed, no stance (range 61000-64999) Jul 1, 2026 payer document Aetna Nerve Blocks (0863) listed, no stance (range 62263-63746) Jul 23, 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: $1724.52 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $1321.82 (chp_plus, non-facility), effective Jul 1, 2026 FL: $1299.11 (physician, non-facility), effective Jan 1, 2026 IL: $1212.69 (practitioner), effective Apr 1, 2024 IN: $1237.53 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $949.17 (default, Exempt Physician), effective Aug 1, 2024 KY: $1020.70 (physician, facility), effective Jan 1, 2026 LA: $1374.54 (professional), effective Jul 1, 2025 MA: $1239.84 (physician_surgery), effective May 1, 2024 MS: $1352.39 (comprehensive), effective Jul 1, 2026 ND: $1672.07 (physician), effective Aug 1, 2026 NE: $2223.00 (physician, non-facility), effective Jul 1, 2026 NY: $723.06 (physician_surgery, facility), effective Jul 1, 2026 OH: $994.31 (physician), effective Jan 1, 2024 OK: $1436.34 (physician, non-facility), effective Jul 1, 2026 TX: $210.87 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2025 VA: $1447.05 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $964.10 (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.