67850 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 67850

Medicaid fee-for-service

  • AZ: $81.18 (asc), effective Oct 1, 2026
  • CO: $160.13 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $90.54 (physician, facility), effective Jan 1, 2026
  • IL: $90.20 (practitioner), effective Jul 1, 2026
  • IN: $101.69 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $225.00 (asc, facility), effective Aug 1, 1982
  • KY: $144.83 (asc), effective Jan 1, 2026
  • LA: $167.59 (professional), effective Jul 1, 2025
  • MA: $130.37 (asc), effective May 1, 2026
  • MS: $116.70 (comprehensive, facility), effective Oct 1, 2025
  • MT: $127.25 (optometric, facility), effective Jul 1, 2025
  • ND: $143.25 (physician, facility), effective Aug 1, 2026
  • NE: $95.87 (physician, facility), effective Jul 1, 2026
  • OH: $85.60 (physician, facility), effective Jan 1, 2024
  • OK: $132.13 (asc), effective Jan 1, 2026
  • TX: $125.97 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $97.51 (medical, facility), effective Jul 1, 2026
  • VT: $774.04 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $67.65 (physician, facility), effective Jul 1, 2026
  • WY: $440.86 (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.