Payer policies › CPT 7205072050 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 72050 Payer coverage policies that name 72050 72050 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: $79.00 (outpatient_hospital), effective Oct 1, 2021 CO: $10.67 (chp_plus, non-facility), effective Jul 1, 2026 FL: $24.89 (radiology), effective Jan 1, 2026 IL: $35.25 (practitioner), effective Apr 1, 2024 IN: $31.06 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $8.10 (default, Exempt Physician), effective Jan 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $41.10 (lab_radiology), effective Jul 1, 2025 MA: $42.10 (physician_radiology), effective May 1, 2024 MS: $43.69 (comprehensive), effective Jul 1, 2026 ND: $46.94 (physician), effective Aug 1, 2026 NE: $44.69 (physician, non-facility), effective Jul 1, 2026 NY: $20.20 (ordered_ambulatory), effective Jul 24, 2026 OH: $36.91 (physician), effective Jan 1, 2024 OK: $11.69 (physician, non-facility), effective Jul 1, 2026 TX: $131.99 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025 VA: $11.28 (medical), effective Jul 1, 2026 VT: $81.18 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $26.56 (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.