69020 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 69020

Medicaid fee-for-service

  • AZ: $96.79 (asc), effective Oct 1, 2026
  • CO: $169.08 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $103.39 (physician, facility), effective Jan 1, 2026
  • IL: $96.59 (practitioner), effective Apr 1, 2024
  • IN: $111.03 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $300.00 (asc, facility), effective Aug 1, 1982
  • KY: $172.68 (asc), effective Jan 1, 2026
  • LA: $217.00 (asc), effective Jul 1, 2012
  • MA: $147.25 (asc), effective May 1, 2026
  • MS: $132.75 (comprehensive, facility), effective Oct 1, 2025
  • ND: $170.80 (physician, facility), effective Aug 1, 2026
  • NE: $93.50 (physician, facility), effective Jul 1, 2026
  • NY: $69.03 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $73.89 (physician, facility), effective Jan 1, 2024
  • OK: $115.37 (physician, facility), effective Jul 1, 2026
  • TX: $147.56 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $115.16 (medical, facility), effective Jul 1, 2026
  • VT: $549.84 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $80.45 (physician, facility), effective Jul 1, 2026
  • WY: $313.16 (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.