Payer policies › CPT 7401974019 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 74019 Medicaid fee-for-service Prior authorization required or conditional in WV.
AZ: $79.00 (outpatient_hospital), effective Oct 1, 2021 CO: $9.03 (chp_plus, non-facility), effective Jul 1, 2026 FL: $7.15 (radiology), effective Jan 1, 2026 IL: $47.34 (practitioner), effective Apr 1, 2024 IN: $19.65 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $6.84 (default, Exempt Physician), effective Jan 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $11.30 (lab_radiology), effective Jul 1, 2025 MA: $8.24 (physician_radiology), effective May 1, 2024 MS: $19.64 (comprehensive), effective Jul 1, 2026 ND: $28.16 (physician), effective Aug 1, 2026 NE: $23.43 (physician, non-facility), effective Jul 1, 2026 NY: $15.15 (ordered_ambulatory), effective Jul 24, 2026 OH: $24.96 (physician), effective Jan 1, 2024 OK: $30.82 (physician, non-facility), effective Jul 1, 2026 TX: $29.40 (family_planning_clinic, Family Planning Clinic, non-facility), effective Mar 1, 2025 VA: $21.99 (medical), effective Jul 1, 2026 VT: $81.18 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $22.36 (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.