Payer policies › CPT 7660476604 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 76604 Payer coverage policies that name 76604 76604 appears in 1 coverage policy from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Magnetic Resonance Imaging of the Cardiovascular System - Cardiac MRI (0520) listed, no stance Aug 20, 2026 payer document
Medicaid fee-for-service AZ: $79.00 (outpatient_hospital), effective Oct 1, 2021 CO: $26.32 (chp_plus, non-facility), effective Jul 1, 2026 FL: $25.98 (radiology), effective Jan 1, 2026 IL: $53.38 (practitioner), effective Apr 1, 2024 IN: $23.45 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $34.06 (default, Exempt Physician), effective Jan 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $54.24 (lab_radiology), effective Jul 1, 2012 MA: $20.33 (physician_radiology), effective May 1, 2024 MS: $23.76 (comprehensive), effective Jul 1, 2026 ND: $37.17 (physician), effective Aug 1, 2026 NE: $103.05 (physician, non-facility), effective Jul 1, 2026 NY: $25.25 (ordered_ambulatory), effective Jul 24, 2026 OH: $54.55 (physician), effective Jan 1, 2024 OK: $52.87 (physician, non-facility), effective Jul 1, 2026 TX: $131.99 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025 VA: $28.93 (medical), effective Jul 1, 2026 VT: $81.18 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $37.46 (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.