Payer policies › CPT 9037690376 CPT® code: payer coverage and prior authorizationPayer policies and prior authorization for 90376 Payer coverage policies that name 90376 90376 appears in 2 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Immune Globulins for Post-Exposure Prophylaxis (0544) covered if criteria are met Oct 7, 2026 payer document Aetna Injectable Medications (0020) listed, no stance (range 90281-90399) Mar 5, 2026 payer document
Medicaid fee-for-service AZ: $334.82 (asc), effective Oct 1, 2026 CO: $274.25 (chp_plus_immunizations), effective Jul 1, 2026 FL: $479.72 (immunization), effective Jul 1, 2026 IN: $403.91 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2023 KS: $479.72 (default), effective Jan 1, 2024 KY: $352.44 (asc), effective Jan 1, 2026 MS: $277.86 (comprehensive, facility), effective Oct 1, 2025 ND: $479.72 (physician), effective Aug 1, 2026 OH: $479.72 (provider_administered_drugs), effective Jan 1, 2024 OK: $453.50 (physician, non-facility), effective Jul 1, 2026 TX: $243.03 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2024 VA: $479.71 (medical), effective Jan 1, 2024 VT: $267.85 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $905.13 (professional_administered_drugs), effective Jul 1, 2026 WY: $152.56 (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.