74355 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 74355

Medicaid fee-for-service

  • AZ: $46.43 (physician, AHCCCS PT 08, facility), effective Oct 1, 2020
  • CO: $29.48 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $23.54 (radiology), effective Jan 1, 2026
  • IL: $118.60 (practitioner), effective Mar 1, 2011
  • IN: $28.53 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $69.73 (default, Exempt Physician), effective Jan 1, 2024
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $91.68 (lab_radiology), effective Jul 1, 2012
  • MA: $26.91 (physician_radiology), effective May 1, 2024
  • MS: $77.92 (comprehensive), effective Jul 1, 2026
  • ND: $38.68 (physician), effective Aug 1, 2026
  • NE: $49.56 (physician, non-facility), effective Jul 1, 2026
  • NY: $40.40 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $100.34 (physician), effective Jan 1, 2018
  • OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026
  • TX: $100.01 (miscellaneous_other_professionals_radiation_treatment_center, Miscellaneous Other Professionals - Radiation Treatment Center, facility), effective Mar 1, 2025
  • VA: $107.61 (medical), effective Jul 1, 2009
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $40.27 (physician, facility), effective Jul 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.