70250 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 70250

Payer coverage policies that name 70250

70250 appears in 4 coverage policies from Aetna, Blue Shield of California, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross.

Medicaid fee-for-service

Prior authorization required or conditional in WV.

• AZ: $79.00 (outpatient_hospital), effective Oct 1, 2021
• CO: $30.30 (chp_plus, non-facility), effective Jul 1, 2026
• FL: $19.66 (radiology), effective Jan 1, 2026
• IL: $46.32 (practitioner), effective Apr 1, 2024
• IN: $20.66 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
• KS: $5.37 (default, Exempt Physician), effective Jan 1, 2024
• KY: $0.00 (asc), effective Jan 1, 2026
• LA: $27.58 (lab_radiology), effective Jul 1, 2025
• MA: $28.38 (physician_radiology), effective May 1, 2024
• MS: $7.44 (comprehensive), effective Jul 1, 2026
• ND: $39.80 (physician), effective Aug 1, 2026
• NE: $30.75 (physician, non-facility), effective Jul 1, 2026
• NY: $15.15 (ordered_ambulatory), effective Jul 24, 2026
• OH: $27.46 (physician), effective Jan 1, 2024
• OK: $30.41 (physician, non-facility), effective Jul 1, 2026
• TX: $131.99 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025
• VA: $7.52 (medical), effective Jul 1, 2026
• VT: $81.18 (outpatient_hospital_opps), effective Feb 1, 2026
• WA: $17.01 (physician, facility), effective Jul 1, 2026
• WY: $46.23 (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.