76776 CPT® code: payer coverage and prior authorization

Payer policies and prior authorization for 76776

Medicaid fee-for-service

  • AZ: $31.31 (asc), effective Oct 1, 2026
  • CO: $29.19 (chp_plus, non-facility), effective Jul 1, 2026
  • FL: $84.42 (radiology), effective Jan 1, 2026
  • IL: $94.57 (practitioner), effective Apr 1, 2024
  • IN: $28.27 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026
  • KS: $22.14 (default, Exempt Physician), effective Jan 1, 2024
  • KY: $55.68 (asc), effective Jan 1, 2026
  • LA: $112.91 (lab_radiology), effective Jul 1, 2025
  • MA: $90.66 (physician_radiology), effective May 1, 2024
  • MS: $45.37 (comprehensive, facility), effective Oct 1, 2025
  • ND: $37.92 (physician), effective Aug 1, 2026
  • NE: $49.06 (physician, non-facility), effective Jul 1, 2026
  • NY: $60.60 (ordered_ambulatory), effective Jul 24, 2026
  • OH: $105.58 (physician), effective Jan 1, 2024
  • OK: $122.07 (physician, non-facility), effective Jul 1, 2026
  • TX: $131.99 (hospital_outpatient_imaging_services, Rural Hospitals), effective Mar 1, 2025
  • VA: $94.04 (medical), effective Jul 1, 2026
  • VT: $81.18 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $68.41 (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.