Payer policies › CPT 7590175901 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 75901 Medicaid fee-for-service AZ: $226.64 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $188.06 (chp_plus, non-facility), effective Jul 1, 2026 FL: $114.83 (radiology), effective Jan 1, 2026 IL: $144.09 (practitioner), effective Apr 1, 2024 IN: $151.86 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KY: $0.00 (asc), effective Jan 1, 2026 LA: $68.72 (lab_radiology), effective Jul 1, 2025 MA: $16.55 (physician_radiology), effective May 1, 2024 MS: $19.20 (comprehensive), effective Jul 1, 2026 ND: $230.55 (physician), effective Aug 1, 2026 NE: $144.88 (physician, non-facility), effective Jul 1, 2026 NY: $108.52 (physician_radiology, facility), effective Apr 1, 2026 OH: $108.25 (physician), effective Jan 1, 2024 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $191.42 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, non-facility), effective Mar 1, 2025 VA: $197.34 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $142.75 (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.