65125 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 65125

Medicaid fee-for-service

  • AZ: $681.35 (asc), effective Oct 1, 2026
  • CO: $184.83 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $202.88 (physician, facility), effective Jan 1, 2026
  • IN: $227.09 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $300.00 (asc, facility), effective Aug 1, 1982
  • KY: $1062.47 (asc), effective Jan 1, 2026
  • LA: $350.98 (professional), effective Jul 1, 2025
  • MA: $711.40 (asc), effective May 1, 2026
  • MS: $820.80 (comprehensive, facility), effective Oct 1, 2025
  • MT: $284.35 (optometric, facility), effective Jul 1, 2025
  • ND: $626.33 (physician, facility), effective Aug 1, 2026
  • NE: $413.00 (asc), effective Jul 1, 2024
  • OH: $146.91 (physician, facility), effective Jan 1, 2024
  • OK: $227.88 (physician, facility), effective Jul 1, 2026
  • TX: $698.30 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $225.98 (medical, facility), effective Jul 1, 2026
  • VT: $1846.02 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $308.28 (asc), effective Jul 1, 2026
  • WY: $1051.41 (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.