Payer policies › CPT 6920069200 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 69200 Payer coverage policies that name 69200 69200 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Intraoperative Neurophysiological Monitoring (0697) covered if criteria are met (range 69200-69222) Jun 19, 2026 payer document
Medicaid fee-for-service AZ: $35.05 (outpatient_hospital, RF133), effective Oct 1, 2024 CO: $47.55 (chp_plus, non-facility), effective Jul 1, 2026 FL: $33.09 (physician, facility), effective Jan 1, 2026 IL: $32.42 (practitioner), effective Apr 1, 2024 IN: $36.71 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $131.25 (asc, facility), effective Aug 1, 1982 KY: $0.00 (asc), effective Jan 1, 2026 LA: $85.26 (professional), effective Feb 1, 2013 MA: $0.00 (asc), effective May 1, 2026 MS: $101.04 (comprehensive), effective Jul 1, 2026 ND: $89.37 (physician), effective Aug 1, 2026 NE: $28.21 (physician, facility), effective Jul 1, 2026 NY: $25.09 (nurse_practitioner, facility), effective Jul 1, 2026 OH: $26.26 (physician, facility), effective Jan 1, 2024 OK: $37.02 (physician, facility), effective Jul 1, 2026 TX: $35.41 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, facility), effective Mar 1, 2026 VA: $36.17 (medical, facility), effective Jul 1, 2026 VT: $103.31 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $24.46 (physician, facility), effective Jul 1, 2026 WY: $58.84 (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.