75809 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 75809

Medicaid fee-for-service

  • AZ: $79.00 (outpatient_hospital), effective Oct 1, 2021
  • CO: $68.13 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $48.06 (radiology), effective Jan 1, 2026
  • IL: $75.13 (practitioner), effective Apr 1, 2024
  • IN: $62.13 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $48.90 (default, Exempt Physician), effective Jan 1, 2024
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $25.11 (lab_radiology), effective Jul 1, 2025
  • MA: $64.74 (physician_radiology), effective May 1, 2024
  • MS: $47.84 (comprehensive), effective Jul 1, 2026
  • ND: $94.62 (physician), effective Aug 1, 2026
  • NE: $30.73 (physician, non-facility), effective Jul 1, 2026
  • NY: $63.22 (physician_radiology, facility), effective Apr 1, 2026
  • OH: $63.62 (physician), effective Jan 1, 2024
  • OK: $72.57 (physician, non-facility), effective Jul 1, 2026
  • TX: $131.99 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025
  • VA: $73.78 (medical), effective Jul 1, 2026
  • VT: $81.18 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $13.76 (physician, facility), effective Jul 1, 2026
  • WY: $46.23 (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.