Payer policies › CPT 7204072040 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 72040 Payer coverage policies that name 72040 72040 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Hyperbaric Oxygen Therapy (HBOT) (0172) listed, no stance Apr 21, 2026 payer document
Medicaid fee-for-service Prior authorization required or conditional in WV.
AZ: $58.65 (outpatient_hospital), effective Oct 1, 2021 CO: $24.63 (chp_plus, non-facility), effective Jul 1, 2026 FL: $17.51 (radiology), effective Jan 1, 2026 IL: $76.62 (practitioner), effective Apr 1, 2024 IN: $8.47 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $16.96 (default, Exempt Physician), effective Jan 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $12.19 (lab_radiology), effective Jul 1, 2025 MA: $8.00 (physician_radiology), effective May 1, 2024 MS: $66.09 (comprehensive), effective Jul 1, 2026 ND: $32.67 (physician), effective Aug 1, 2026 NE: $45.33 (chiropractor, non-facility), effective Jul 1, 2026 NY: $15.15 (ordered_ambulatory), effective Jul 24, 2026 OH: $25.13 (physician), effective Jan 1, 2024 OK: $33.86 (physician, non-facility), effective Jul 1, 2026 TX: $109.09 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025 VA: $34.43 (medical), effective Jul 1, 2026 VT: $67.57 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $6.12 (chiropractic_services_for_children, non-facility), effective Jul 1, 2026 WY: $38.49 (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.