69720 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 69720

Payer coverage policies that name 69720

69720 appears in 4 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaFacial Nerve Paralysis (0745)not coveredOct 30, 2025payer document
AetnaGrid Monitoring and Intraoperative Electroencephalography (0289)listed, no stance (range 69720-69745)Apr 17, 2026payer document
AetnaIntraoperative Neurophysiological Monitoring (0697)covered if criteria are met (range 69720-69745)Jun 19, 2026payer document
AetnaMyringotomy and Tympanostomy Tube (0418)listed, no stance (range 69420-69799)Jun 30, 2026payer document

Medicaid fee-for-service

  • AZ: $1943.46 (asc), effective Oct 1, 2026
  • CO: $972.74 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $824.25 (physician, non-facility), effective Jan 1, 2026
  • IL: $794.45 (practitioner), effective Apr 1, 2024
  • IN: $902.78 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $450.00 (asc, facility), effective Aug 1, 1982
  • KY: $2953.46 (asc), effective Jan 1, 2026
  • LA: $233.58 (asc), effective Jul 1, 2012
  • MA: $1909.57 (asc), effective May 1, 2026
  • MS: $2333.88 (comprehensive, facility), effective Oct 1, 2025
  • ND: $1741.07 (physician, facility), effective Aug 1, 2026
  • NE: $1233.00 (asc), effective Jul 1, 2024
  • NY: $567.97 (physician_surgery, facility), effective Jul 1, 2026
  • OH: $854.51 (physician), effective Jan 1, 2024
  • OK: $2694.50 (asc), effective Jan 1, 2026
  • TX: $1954.22 (ambulatory_surgical_center_asc_hospital_based_ambulatory_sur, Ambulatory Surgical Center (Asc) / Hospital - Based Ambulatory Surgical Center (Hasc)), effective Jun 1, 2023
  • VA: $918.11 (medical), effective Jul 1, 2026
  • VT: $4596.52 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $366.60 (asc), effective Jul 1, 2026
  • WY: $2617.97 (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.