Payer policies › CPT 7477574775 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 74775 Medicaid fee-for-service AZ: $72.45 (asc), effective Oct 1, 2026 CO: $34.11 (chp_plus, non-facility), effective Jul 1, 2026 IL: $71.20 (practitioner), effective Jul 1, 2026 IN: $23.27 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $77.20 (asc, facility), effective Jul 1, 2019 KY: $128.34 (asc), effective Jan 1, 2026 LA: $23.34 (lab_radiology), effective Jul 1, 2012 MA: $22.14 (physician_radiology), effective May 1, 2024 MS: $104.22 (comprehensive, facility), effective Oct 1, 2025 ND: $0.00 (physician), effective Aug 1, 2026 NE: $41.05 (physician, non-facility), effective Jul 1, 2026 NY: $30.30 (ordered_ambulatory), effective Jul 24, 2026 OH: $125.73 (physician), effective Jan 1, 2018 OK: $117.09 (asc), effective Jan 1, 2026 TX: $294.17 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025 VA: $42.06 (medical), effective Oct 1, 2010 VT: $185.27 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $17.01 (physician, facility), effective Jul 1, 2026 WY: $105.52 (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.