67415 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 67415

Medicaid fee-for-service

  • AZ: $681.35 (asc), effective Oct 1, 2026
  • CO: $80.75 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $68.42 (physician, non-facility), effective Jan 1, 2026
  • IL: $68.40 (practitioner), effective Apr 1, 2024
  • IN: $79.29 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $184.43 (asc, facility), effective Aug 1, 1982
  • KY: $1062.47 (asc), effective Jan 1, 2026
  • LA: $182.30 (asc), effective Jul 1, 2012
  • MA: $711.40 (asc), effective May 1, 2026
  • MS: $820.80 (comprehensive, facility), effective Oct 1, 2025
  • MT: $98.51 (optometric, facility), effective Jul 1, 2025
  • ND: $626.33 (physician, facility), effective Aug 1, 2026
  • NE: $413.00 (asc), effective Jul 1, 2024
  • OH: $88.99 (physician), effective Jul 1, 2008
  • OK: $969.31 (asc), effective Jan 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: $71.18 (medical), 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.