64786 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 64786

Payer coverage policies that name 64786

64786 appears in 3 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaIntravenous Iron Therapy (0575)listed, no stance (range 61000-64999)Jul 1, 2026payer document
AetnaRespiratory Devices: Incentive Spirometers, Vaporizers and Intermittent Positive Pressure Breathing Machines (0479)listed, no stance (range 61000-64999)Jul 9, 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: $1296.54 (asc), effective Oct 1, 2026
  • CO: $792.62 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $739.83 (physician, non-facility), effective Jan 1, 2026
  • IL: $710.05 (practitioner), effective Apr 1, 2024
  • IN: $756.25 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $673.00 (default, Exempt Physician), effective Aug 1, 2024
  • KY: $2125.55 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $1844.70 (asc), effective May 1, 2026
  • MS: $2471.70 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1253.01 (physician, facility), effective Aug 1, 2026
  • NE: $637.00 (asc), effective Jul 1, 2024
  • NY: $515.63 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $796.99 (physician), effective Jan 1, 2024
  • OK: $1939.18 (asc), effective Jan 1, 2026
  • TX: $1996.58 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $824.07 (medical), effective Jul 1, 2026
  • VT: $2652.51 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1510.75 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.