Payer policies › CPT 7700377003 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 77003 Payer coverage policies that name 77003 77003 appears in 7 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi.
Payer Policy Role in policy Reviewed Document Aetna Back Pain - Invasive Procedures (0016) listed, no stance Oct 6, 2026 payer document Aetna Epidural Injection Technologies (0934) listed, no stance Apr 8, 2025 payer document Aetna Nusinersen (Spinraza) (0915) listed, no stance Sep 9, 2026 payer document Aetna Transforaminal Epidural Injections (0722) listed, no stance Oct 20, 2025 payer document Aetna Viscosupplementation (0179) not covered Sep 2, 2026 payer document Blue Cross & Blue Shield of Mississippi Decompression Of The Intervertebral Disc Using Laser Energy Laser Discectomy Or Radiofrequency Coblation Nucleoplasty unproven / investigational payer document Blue Cross & Blue Shield of Mississippi Diagnosis And Treatment Of Sacroiliac Joint Pain (L.6.01.413) covered if criteria are met payer document
Medicaid fee-for-service Prior authorization required or conditional in WV.
AZ: $104.95 (physician, AHCCCS PT 08, facility), effective Oct 1, 2025 CO: $86.42 (chp_plus, non-facility), effective Jul 1, 2026 FL: $14.37 (radiology), effective Jan 1, 2026 IL: $67.80 (practitioner), effective Apr 1, 2024 IN: $22.22 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $17.50 (default, Exempt Physician), effective Jan 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $32.37 (lab_radiology), effective Jul 1, 2025 MA: $21.12 (physician_radiology), effective May 1, 2024 MS: $58.98 (comprehensive), effective Jul 1, 2026 ND: $85.24 (physician), effective Aug 1, 2026 NE: $93.55 (physician, non-facility), effective Jul 1, 2026 NY: $25.25 (ordered_ambulatory), effective Jul 24, 2026 OH: $55.71 (physician), effective Jan 1, 2024 OK: $0.00 (outpatient_hospital_apc), effective Jan 1, 2026 TX: $62.87 (miscellaneous_other_professionals_portable_x_ray_radiologica, Miscellaneous Other Professionals - Portable X-Ray, Radiological Lab, Physiological Lab, non-facility), effective Mar 1, 2026 VA: $24.59 (medical), effective Jul 1, 2026 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $47.97 (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.