65275 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 65275

Medicaid fee-for-service

  • AZ: $1154.93 (asc), effective Oct 1, 2026
  • CO: $299.30 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $313.89 (physician, facility), effective Jan 1, 2026
  • IL: $359.30 (practitioner), effective Jul 1, 2026
  • IN: $353.76 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $400.00 (asc, facility), effective Aug 1, 1982
  • KY: $1694.34 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $1152.29 (asc), effective May 1, 2026
  • MS: $1269.63 (comprehensive, facility), effective Oct 1, 2025
  • MT: $441.29 (optometric, facility), effective Jul 1, 2025
  • ND: $998.81 (physician, facility), effective Aug 1, 2026
  • NE: $785.00 (asc), effective Jul 1, 2024
  • NY: $191.64 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $231.69 (physician, facility), effective Jan 1, 2024
  • OK: $1545.78 (asc), effective Jan 1, 2026
  • TX: $1103.42 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $336.81 (medical, facility), effective Jul 1, 2026
  • VT: $3052.58 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $339.40 (asc), effective Jul 1, 2026
  • WY: $1738.61 (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.