74290 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 74290

Medicaid fee-for-service

  • AZ: $129.45 (outpatient_hospital), effective Oct 1, 2021
  • CO: $12.54 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $9.88 (radiology), effective Jan 1, 2026
  • IL: $54.27 (practitioner), effective Apr 1, 2024
  • IN: $51.59 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $51.71 (default, Exempt Physician), effective Jan 1, 2024
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $25.89 (lab_radiology), effective Jul 1, 2025
  • MA: $69.23 (physician_radiology), effective May 1, 2024
  • MS: $12.61 (comprehensive), effective Jul 1, 2026
  • ND: $90.49 (physician), effective Aug 1, 2026
  • NE: $64.91 (physician, non-facility), effective Jul 1, 2026
  • NY: $20.20 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $45.86 (physician), effective Jan 1, 2024
  • OK: $13.25 (physician, non-facility), effective Jul 1, 2026
  • TX: $220.58 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025
  • VA: $70.31 (medical), effective Jul 1, 2026
  • VT: $136.19 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $8.60 (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.