Payer policies › CPT 6521065210 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 65210 Medicaid fee-for-service AZ: $2.44 (outpatient_hospital, RF133), effective Oct 1, 2025 CO: $31.42 (chp_plus, non-facility), effective Jul 1, 2026 FL: $24.59 (physician, facility), effective Jan 1, 2026 IL: $33.87 (practitioner), effective Apr 1, 2024 IN: $28.08 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $400.00 (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: $339.25 (comprehensive), effective Jul 1, 2026 MT: $34.56 (optometric, facility), effective Jul 1, 2025 ND: $42.06 (physician), effective Aug 1, 2026 NE: $70.68 (physician, facility), effective Jul 1, 2026 NY: $23.06 (physician_surgery, facility), effective Jul 1, 2026 OH: $29.41 (physician, facility), effective Jan 1, 2024 OK: $27.00 (physician, facility), effective Jul 1, 2026 TX: $38.61 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Sep 1, 2024 VA: $26.04 (medical, facility), effective Jul 1, 2026 VT: $346.86 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $17.96 (physician, facility), effective Jul 1, 2026 WY: $197.56 (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.