65205 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 65205

Medicaid fee-for-service

  • AZ: $81.16 (outpatient_hospital), effective Oct 1, 2021
  • CO: $23.14 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $19.76 (physician, facility), effective Jan 1, 2026
  • IL: $27.55 (practitioner), effective Apr 1, 2024
  • IN: $22.49 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $225.00 (asc, facility), effective Aug 1, 1982
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $0.00 (asc), effective May 1, 2026
  • MS: $101.04 (comprehensive), effective Jul 1, 2026
  • MT: $27.77 (optometric, facility), effective Jul 1, 2025
  • ND: $31.17 (physician), effective Aug 1, 2026
  • NE: $41.43 (physician, facility), effective Jul 1, 2026
  • NY: $19.07 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $26.15 (physician, facility), effective Jan 1, 2024
  • OK: $21.92 (physician, facility), effective Jul 1, 2026
  • TX: $32.22 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2024
  • VA: $21.12 (medical, facility), effective Jul 1, 2026
  • VT: $103.31 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $14.52 (physician, facility), effective Jul 1, 2026
  • WY: $58.84 (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.