74221 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 74221

Medicaid fee-for-service

  • AZ: $129.45 (outpatient_hospital), effective Oct 1, 2021
  • CO: $27.00 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $24.94 (radiology), effective Jan 1, 2026
  • IL: $70.72 (practitioner), effective Apr 1, 2024
  • IN: $26.12 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $20.45 (default, Exempt Physician), effective Jan 1, 2024
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $84.51 (lab_radiology), effective Jul 1, 2025
  • MA: $24.64 (physician_radiology), effective May 1, 2024
  • MS: $56.91 (comprehensive), effective Jul 1, 2026
  • ND: $82.23 (physician), effective Aug 1, 2026
  • NE: $126.98 (physician, non-facility), effective Jul 1, 2026
  • NY: $25.19 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $86.67 (physician), effective Jan 1, 2024
  • OK: $28.94 (physician, non-facility), effective Jul 1, 2026
  • TX: $220.58 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025
  • VA: $27.78 (medical, facility), effective Jul 1, 2026
  • VT: $136.19 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $65.36 (physician, facility), effective Jul 1, 2026
  • WY: $77.57 (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.