Payer policies › CPT 6486564865 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 64865 Payer coverage policies that name 64865 64865 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: $1614.66 (asc), effective Oct 1, 2026 CO: $874.16 (chp_plus, non-facility), effective Jul 1, 2026 FL: $746.82 (physician, non-facility), effective Jan 1, 2026 IL: $861.50 (practitioner), effective Jul 1, 2026 IN: $830.63 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $300.00 (asc, facility), effective Aug 1, 1982 KY: $2693.09 (asc), effective Jan 1, 2026 LA: $217.00 (asc), effective Jul 1, 2012 MA: $1844.70 (asc), effective May 1, 2026 MS: $3132.79 (comprehensive, facility), effective Oct 1, 2025 ND: $1587.58 (physician, facility), effective Aug 1, 2026 NE: $1000.00 (asc), effective Jul 1, 2024 NY: $561.94 (physician_surgery, facility), effective Jul 1, 2026 OH: $771.53 (physician), effective Jan 1, 2024 OK: $2456.96 (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: $821.18 (medical), effective Jul 1, 2026 VT: $2652.51 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $366.60 (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.