Payer policies › CPT 7208072080 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 72080 Payer coverage policies that name 72080 72080 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: $29.14 (chp_plus, non-facility), effective Jul 1, 2026 FL: $6.26 (radiology), effective Jan 1, 2026 IL: $25.40 (practitioner), effective Apr 1, 2024 IN: $26.57 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $20.62 (default, Exempt Physician), effective Jan 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $26.69 (lab_radiology), effective Jul 1, 2025 MA: $7.48 (physician_radiology), effective May 1, 2024 MS: $27.94 (comprehensive), effective Jul 1, 2026 ND: $11.26 (physician), effective Aug 1, 2026 NE: $32.20 (physician, non-facility), effective Jul 1, 2026 NY: $15.15 (ordered_ambulatory), effective Jul 24, 2026 OH: $26.95 (physician), effective Jan 1, 2024 OK: $20.91 (physician, non-facility), effective Jul 1, 2026 TX: $109.09 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025 VA: $30.38 (medical), effective Jul 1, 2026 VT: $67.57 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $21.79 (physician, 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.