Payer policies › CPT 6972569725 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 69725 Payer coverage policies that name 69725 69725 appears in 4 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Facial Nerve Paralysis (0745) not covered Oct 30, 2025 payer document Aetna Grid Monitoring and Intraoperative Electroencephalography (0289) listed, no stance (range 69720-69745) Apr 17, 2026 payer document Aetna Intraoperative Neurophysiological Monitoring (0697) covered if criteria are met (range 69720-69745) Jun 19, 2026 payer document Aetna Myringotomy and Tympanostomy Tube (0418) listed, no stance (range 69420-69799) Jun 30, 2026 payer document
Medicaid fee-for-service AZ: $1943.46 (asc), effective Oct 1, 2026 CO: $1496.53 (chp_plus, non-facility), effective Jul 1, 2026 FL: $1286.38 (physician, non-facility), effective Jan 1, 2026 IL: $1273.03 (practitioner), effective Apr 1, 2024 IN: $1430.42 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $1153.37 (default, Exempt Physician), effective Aug 1, 2024 KY: $2953.46 (asc), effective Jan 1, 2026 LA: $233.58 (asc), effective Jul 1, 2012 MA: $1414.68 (physician_surgery), effective May 1, 2024 MS: $4495.60 (comprehensive), effective Jul 1, 2026 ND: $1740.41 (physician), effective Aug 1, 2026 NE: $2964.00 (physician, non-facility), effective Jul 1, 2026 NY: $912.97 (physician_surgery, facility), effective Jul 1, 2026 OH: $1086.54 (physician), effective Jan 1, 2024 OK: $1435.42 (physician, non-facility), effective Jul 1, 2026 TX: $220.27 (certified_nurse_midwife_cnm, Certified Nurse Midwife (Cnm), facility), effective Mar 1, 2026 VA: $1408.57 (medical), effective Jul 1, 2026 VT: $4596.52 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $961.42 (physician, facility), 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.