Payer policies › CPT 6486464864 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 64864 Payer coverage policies that name 64864 64864 appears in 6 coverage policies from Aetna, Anthem.
Payer Policy Role in policy Reviewed Document Aetna Facial Nerve Paralysis (0745) covered if criteria are met (range 64864-64865) Oct 30, 2025 payer document Aetna Intravenous Iron Therapy (0575) listed, no stance (range 61000-64999) Jul 1, 2026 payer document Aetna Paralytic Lagophthalmos Treatments (0366) covered if criteria are met May 22, 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 Anthem Cosmetic and Reconstructive Services of the Head and Neck (ANC.00008) covered if criteria are met (range 64864-64865) Aug 13, 2026 payer document
Medicaid fee-for-service AZ: $3924.14 (asc), effective Oct 1, 2026 CO: $689.29 (chp_plus, non-facility), effective Jul 1, 2026 FL: $597.23 (physician, non-facility), effective Jan 1, 2026 IL: $599.35 (practitioner), effective Jul 1, 2026 IN: $660.81 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $560.68 (default, Exempt Physician), effective Aug 1, 2024 KY: $4066.84 (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: $2397.40 (physician, facility), effective Aug 1, 2026 NE: $1000.00 (asc), effective Jul 1, 2024 NY: $420.60 (physician_surgery, facility), effective Jul 1, 2026 OH: $587.75 (physician), effective Jan 1, 2024 OK: $3710.26 (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: $654.22 (medical), effective Jul 1, 2026 VT: $6814.11 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $415.35 (asc), effective Jul 1, 2026 WY: $3881.00 (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.