Payer policies › CPT 7609876098 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 76098 Payer coverage policies that name 76098 76098 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Breast Biopsy Procedures (0269) listed, no stance May 14, 2026 payer document
Medicaid fee-for-service AZ: $350.10 (outpatient_hospital), effective Oct 1, 2021 CO: $12.27 (chp_plus, non-facility), effective Jul 1, 2026 FL: $7.90 (radiology), effective Jan 1, 2026 IL: $27.71 (practitioner), effective Apr 1, 2024 IN: $11.83 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $25.05 (default, Exempt Physician), effective Jan 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $13.22 (lab_radiology), effective Jul 1, 2025 MA: $11.20 (physician_radiology), effective May 1, 2024 MS: $414.96 (comprehensive), effective Jul 1, 2026 ND: $16.15 (physician), effective Aug 1, 2026 NE: $29.06 (physician, non-facility), effective Jul 1, 2026 NY: $12.35 (physician_radiology, facility), effective Apr 1, 2026 OH: $20.01 (physician), effective Jan 1, 2024 OK: $36.92 (physician, non-facility), effective Jul 1, 2026 TX: $12.03 (healthy_texas_women, Clinic/Group Practice, facility), effective Sep 1, 2021 VA: $12.73 (medical), effective Jul 1, 2026 VT: $424.27 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $17.96 (physician, facility), effective Jul 1, 2026 WY: $241.65 (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.