74425 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 74425

Medicaid fee-for-service

  • AZ: $241.82 (outpatient_hospital), effective Oct 1, 2021
  • CO: $19.44 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $10.95 (radiology), effective Jan 1, 2026
  • IL: $86.43 (practitioner), effective Apr 1, 2024
  • IN: $102.02 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $66.73 (default, Exempt Physician), effective Jan 1, 2024
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $41.30 (lab_radiology), effective Jul 1, 2025
  • MA: $17.71 (physician_radiology), effective May 1, 2024
  • MS: $20.36 (comprehensive), effective Jul 1, 2026
  • ND: $149.82 (physician), effective Aug 1, 2026
  • NE: $208.36 (physician, non-facility), effective Jul 1, 2026
  • NY: $20.20 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $116.03 (physician), effective Jan 1, 2018
  • OK: $314.16 (outpatient_hospital_apc), effective Jan 1, 2026
  • TX: $461.69 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025
  • VA: $38.20 (medical), effective Oct 1, 2010
  • VT: $270.89 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $69.56 (physician, facility), effective Jul 1, 2026
  • WY: $154.28 (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.