Payer policies › CPT 7705377053 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 77053 Payer coverage policies that name 77053 77053 appears in 3 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Breast Biopsy Procedures (0269) listed, no stance (range 77053-77054) May 14, 2026 payer document Aetna Breast Ductal Lavage and Fiberoptic Ductoscopy (0517) listed, no stance Aug 5, 2026 payer document Aetna Kidney Transplantation (0493) listed, no stance (range 77053-77054) Jul 30, 2026 payer document
Medicaid fee-for-service AZ: $166.84 (outpatient_hospital), effective Oct 1, 2021 CO: $31.14 (chp_plus, non-facility), effective Jul 1, 2026 FL: $28.31 (radiology), effective Jan 1, 2026 IL: $49.88 (practitioner), effective Apr 1, 2024 IN: $27.76 (professional, Advanced Practice Nurse (85%), facility), effective Jan 1, 2026 KS: $10.54 (default, Exempt Physician), effective Jan 1, 2024 KY: $0.00 (asc), effective Jan 1, 2026 LA: $63.71 (lab_radiology), effective Jul 1, 2012 MA: $41.82 (physician_radiology), effective May 1, 2024 MS: $28.18 (comprehensive), effective Jul 1, 2026 ND: $18.40 (physician), effective Aug 1, 2026 NE: $23.79 (physician, non-facility), effective Jul 1, 2026 NY: $30.30 (ordered_ambulatory), effective Jul 24, 2026 OH: $43.17 (physician), effective Jan 1, 2024 OK: $45.47 (physician, non-facility), effective Jul 1, 2026 TX: $13.63 (healthy_texas_women, Clinic/Group Practice, facility), effective Jan 1, 2019 VA: $16.96 (medical), effective Jul 1, 2026 VT: $185.27 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $9.94 (physician, facility), effective Jul 1, 2026 WY: $105.52 (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.