68530 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 68530

Medicaid fee-for-service

  • AZ: $98.29 (asc), effective Oct 1, 2026
  • CO: $251.86 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $173.49 (physician, facility), effective Jan 1, 2026
  • IL: $174.60 (practitioner), effective Jul 1, 2026
  • IN: $195.84 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $136.50 (asc, facility), effective Aug 1, 1982
  • KY: $169.94 (asc), effective Jan 1, 2026
  • LA: $336.37 (professional), effective Jul 1, 2025
  • MA: $116.18 (asc), effective May 1, 2026
  • MS: $128.09 (comprehensive, facility), effective Oct 1, 2025
  • MT: $243.91 (optometric, facility), effective Jul 1, 2025
  • ND: $100.18 (physician, facility), effective Aug 1, 2026
  • NE: $446.35 (physician, facility), effective Jul 1, 2026
  • NY: $115.29 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $126.49 (physician, facility), effective Jan 1, 2024
  • OK: $188.96 (physician, facility), effective Jul 1, 2026
  • TX: $108.29 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $184.32 (medical, facility), effective Jul 1, 2026
  • VT: $246.45 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $127.08 (physician, facility), effective Jul 1, 2026
  • WY: $140.37 (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.